Full-Time Director, Provider Credentialing & Enrollment (NCQA)

• Oversee Provider Credentialing and Payer Enrollment nationally.
• SME for payer matters and reviewing credentialing issues.
• Collaborate with Payer Contracting, Revenue Cycle Management, and other areas.
• Manage the national credentialing team.
• Assure compliance with health plan requirements.
• Train and manage Credentialing & Enrollment leaders.
• Manage processes that maintain up-to-date provider data.
• Maintain confidentiality of provider information.
• Manage credentialing and payer enrollment processes for Managed Service Organizations (MSOs).
• Create and manage process and quality improvement efforts.
• Design and review credentialing statistics.
• Develop and execute a strategic plan for Provider Enrollment and Credentialing.
• Evaluate and manage new technologies to improve efficiency.
• Ensure the team is fully trained.
• Other duties as assigned.

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