Full-Time Director, Provider Credentialing & Enrollment

• Oversee Provider Credentialing and Payer Enrollment on a national level.
• Subject Matter Expert for payer related matters and reviewing payer or credentialing issues related to growth.
• Work collaboratively with various departments to ensure accurate information sharing.
• Manage the national team of credentialing resources.
• Assure compliance with all health plan requirements.
• Oversee teams responsible for special projects.
• Train and manage Credentialing & Enrollment leaders.
• Manage processes that maintain up-to-date provider data.
• Maintain confidentiality of provider information.
• Assist in managing information flow between payers, MSOs and PMG.
• Oversee end-to-end credentialing and payer enrollment processes for MSOs.
• Coordinate and prepare management reports.
• Create and manage process and quality improvement efforts.
• Design and review credentialing statistics.
• Develop and execute a long-term strategic plan.
• Evaluate, recommend, and manage the implementation of new technologies.
• Ensure team is fully trained.
• Other duties as assigned.

• 7+ years experience in managed care credentialing required.
• Comprehensive knowledge of NCQA standards.
• Extensive people management experience.
• Demonstrated skills in problem solving and analysis.
• Must be able to function independently.

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