Manager Provider Credentialing & Enrollment
Evansville, Indiana, United States
USD 47K-66K (estimate) Mid-level Full Time
Tasks
- Create update and enforce credentialing enrollment policies
- Drive process improvement automation and standardization initiatives
- Ensure compliance with CMS and state regulations and payer requirements
- Ensure primary source verification accuracy
- Ensure timely enrollment to prevent reimbursement delays
- Lead and develop credentialing and enrollment staff
- Lead payer enrollment Medicare Medicaid and managed care
- Lead provider credentialing operations
- Maintain audit ready credentialing records
- Maintain provider demographic credentialing and enrollment data integrity
- Monitor KPI reporting turnaround times and quality metrics
- Monitor payer enrollment performance and aging metrics
- Oversee exclusion screening and sanction monitoring processes
- Oversee licensure board certification sanctions exclusions malpractice monitoring
- Oversee provider and facility revalidations updates and terminations
- Support internal and external audits and accreditation reviews
- Support provider data governance initiatives
Perks/Benefits
- N/A
Skills/Tech-stack
Audit Support | Compliance Management | Credentialing | Data Governance | Data Integrity | Exclusion Screening | KPI Reporting | Managed care | Medicaid | Medicare | Policy Development | Primary Source Verification | Process Improvement | Provider enrollment | Revalidation | Sanctions monitoring | Source verification | Workflow automation
Education
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