Provider Credentialing & Enrollment Manager

The Provider Credentialing and Enrollment Manager will oversee the processing of applications and reapplications for providers, ensuring compliance with national accreditation standards and state and federal regulatory requirements. The position requires a subject matter expert in all state bylaws of the credentialing process and application management, specifically tailored for urgent care environments.

Requirements

• Ensure provider staff is credentialed and enrolled with payers to ensure sufficient clinical coverage and minimal claims reimbursement denials
• Develop and implement policies and procedures for the credentialing and recredentialing process, ensuring they meet industry standards and organizational needs
• Manage the primary source verification of education, training, board certification, work history, and licensure of healthcare providers
• Maintain CMS NPPES reporting
• Support internal credentialing committee in evaluation of newly hired staff
• Facilitate the resolution of discrepancies or concerns regarding applicants' credentials, working closely with medical staff leadership and healthcare providers
• Maintain accurate and confidential credentialing databases and files, ensuring the security and integrity of sensitive provider information
• Effectively communicate accurate enrollment and credentialing status throughout the organization to support effective decision making
• Assist the accounts receivable department with credentialing related payer denials
• Coordinate with counsel and compliance on malpractice and related insurance coverage
• Serve as the lead expert on all state-specific bylaws, ensuring that urgent care and health system applications adhere to varying regional legal standards.

Benefits

• Health insurance
• 401(k) plan
• Paid time off
• Retirement plan