Provider Credentialing & Enrollment Manager
PM Pediatric Care
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $95,000 - $110,000 per year
About the role
- 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
- 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
- Maintain accurate and confidential credentialing databases and files
- Communicate accurate enrollment and credentialing status throughout the organization
- 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
Requirements
- Minimum of five (5) years of progressively responsible operational or consulting experience in provider credentialing and enrollment in an outpatient setting
- Proven expertise in all state bylaws governing the credentialing process for urgent care or multi-site health systems
- Knowledge and experience of the healthcare industry or medical financial operations
- Possess ability to identify patterns and conduct root cause analysis
- Maintain accurate and up-to-date provider credentialing information in the database
- Experience with CAQH (Council for Affordable Quality Healthcare) database and application process
- Strong attention to detail and organizational skills
- Demonstrated ability to manage multiple, concurrently running projects and adapt to changing deadlines, competing priorities and unexpected assignments
Benefits
- Health insurance
- PTO
- Flexible work arrangements
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
provider credentialingenrollment processesprimary source verificationroot cause analysiscredentialing policiesclaims reimbursementmalpractice insurance coveragecredentialing databasesCMS NPPES reportingCAQH database
Soft Skills
attention to detailorganizational skillscommunication skillsproject managementproblem-solvingadaptabilityinterpersonal skillsconfidentialityevaluation skillsdiscrepancy resolution