Full-Time AVP, Credentialing & Payer Enrollment

• Oversee Provider Credentialing and Payer Enrollment nationally.
• Subject Matter Expert for payer matters and business growth issues.
• Collaborate with various departments for accurate information sharing.
• Lead the national credentialing team, ensuring consistency in training and resource management.
• Assure compliance with government and health plan requirements.
• Oversee teams responsible for special projects and software maintenance.
• Develop leaders on the team.
• Create processes for up-to-date provider data.
• Utilize Robotic Process Automation (RPA) for scalability.
• Maintain provider information confidentiality.
• Manage information flow and prepare reports.
• Manage process and quality improvement efforts.
• Design credentialing statistics for improvement.
• Ensure team training and independence.
• Oversee athena tablespace builds and updates.
• Other duties as assigned.

• 10+ years’ experience in managed care credentialing or Medical Staff service.
• Problem-solving and analytical skills.
• Ability to function independently and manage multiple projects.
• Eagerness to build a Credentialing and Enrollment department.
• Effective communication skills.
• Attention to detail and organizational skills.
• Executive presence and ability to present complex information.
• Knowledge of NCQA, Joint Commission, URAC, CMS, and State Laws.
• Ability to problem solve and use available resources.
• Prioritization skills and ability to meet deadlines.
• athena and EPIC experience preferred.

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