Regular Full Time (Monday-Friday, 8:00AM-5:00PM)

Responsibilities:

Payer Credentialing and Enrollment Program Functions

• Develops and implements communication strategy to accurately update and maintain all internal systems and resources with appropriate provider and network participation information. Communicates provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for professional services rendered. 
• Accurately completes or provides for the completion of the enrollment/reenrollment processes as outlined by each payer for all appropriate healthcare providers to ensure timely and continued provider network participation. Ensure productivity levels are met as necessary.
• Manages group level credentialing, contracting and enrollment processes with third party and governmental payers e.g. reporting of group practice changes to Medicare via 855B updates, Medicaid re-enrollments, working with new payer contracts to enroll group/providers. 

• Participate in regular practitioner recruitment, onboarding and offboarding committees as lead resource for payer credentialing function. Provide necessary reports and updates to these committees.

• Troubleshoots concerns throughout the onboarding process and works with multi-disciplinary practice personnel to find appropriate solutions to ensure timely completion of tasks.

• Works closely with internal constituents and Senior Leadership to continually develop the onboarding program and assess for effectiveness.

Data Analytics and Oversight

• Lead report development and management for payer credentialing functions, including designing, maintaining, and continuously improving dashboards and operational reports to monitor performance, volume, and outcomes.
• Establish and oversee staff productivity standards, ensuring measurable benchmarks are defined, tracked, and aligned with organizational goals; provide regular performance feedback and coaching based on productivity data.
• Manage and enforce timelines and due dates for all credentialing activities, including initial enrollments, revalidations, re-credentialing, and payer updates, ensuring compliance with internal SLAs and external payer requirements.
• Implement and maintain robust tracking systems to monitor credentialing status across all payers, ensuring transparency, data accuracy, and timely escalation of issues or delays.
• Analyze workflow metrics and trends to identify process improvement opportunities, optimize turnaround times, and enhance overall team efficiency.
• Collaborate with cross-functional teams (e.g., contracting, compliance, operations) to ensure credentialing data integrity and alignment with business needs.
• Prepare and deliver regular operational reports to leadership, summarizing productivity, backlog, aging, and key performance indicators (KPIs).
• Ensure compliance with regulatory, payer, and organizational standards within all credentialing processes.

Human Resources/Personnel Management

• Responsible for the supervision of credentialing and enrollment staff including recruiting, training, evaluating and monitoring quality of work and productivity of the department. Establishes work schedules and ensures appropriate resources to complete work within established guidelines. Verifies and approves weekly payroll.  Monitors and reviews hours worked for supervised staff as well as overall attendance patterns to ensure adequate staffing to meet departmental requirements.
• Responsible for administering an effective performance management program ensuring that departmental job descriptions are reflective of current responsibilities, defining and administering a career progression for staff seeking advancement, ensuring that performance management tools (e.g. metrics, review templates) are reflective of current responsibilities and performance standards, clearly communicating performance expectations to staff, completing and administering meaningful performance reviews on time, and issuing and monitoring corrective performance management plan as is appropriate and indicated up to and including termination for continued non-performance.

Policy Development

•  Responsible for the research, development, implementation, maintenance of and compliance with policies, procedures, and guidelines related to third party enrollment, provider licensure and credentials, compliance and the overall revenue cycle.
• Assures employees are familiar with, have access to, and comply with policies, procedures, reference materials which conform to current regulatory requirements.  Arranges for staff to attend internal and external education as needed.
• Keeps informed regarding current regulations, insurance company policies, professional standards and company/department policies and procedures and effectively applies this knowledge.

Qualifications:

• Bachelor’s Degree and five years of professionally related experience in provider enrollment and credentialing in a healthcare setting.
• Minimum of three years in a supervisory role with demonstrated ability to provide employee performance and skill development feedback and guidance including performance evaluations, mentoring and performance improvement plans up to and including termination.

• Strong problem-solving skills and ability to make timely decisions in a fast-paced environment.

• Willingness and ability to empower, delegate and monitor staff performance, encourage the development of innovative and effective solutions by staff and facilitate those solutions through implementation.

• Experience with credentialing platforms and reporting tools and computer software such as MS Office or equivalent is required. (e.g., Excel, Power BI, Tableau). Prefer candidates with Epic (EHR) and Credential Stream (Medical staff and Payer) system experience.