Credentialing and Enrollment Manager

Description

Accurate and timely credentialing and enrollment of healthcare professionals are vital elements to supporting our community's access to high-quality patient care.  This position matters!

Who are we looking for?  

A candidate who can easily drive to any of our site locations (Ukiah, Willits, Lakeport).  This can be a hybrid position, with the initial few months being 4-5 days a week on-site, and then transitioning to 1-2 days per week on-site.   

An experienced credentialing specialist who enjoys digging into the details, refining processes, and is highly organized.  Who enjoys partnering with internal and external customers, and can maneuver seamlessly to accomplish what others may feel is impossible.  

Key Responsibilities:

- Verify and maintain the credentials of healthcare professionals, including licenses, certifications, and educational qualifications

- Manage the enrollment process of healthcare providers with multiple payor insurance plans

- Ensure timely submission of credentialing and re-credentialing applications

- Communicate effectively with Credentialing Verification Organization, healthcare providers, insurance companies, and internal leaders to resolve issues

- Manage expenses and reduce cost/reliance upon CVO

- Monitor and track credentialing and enrollment statuses to ensure compliance with regulatory requirements

Skills and Qualifications:

- Strong organizational and administrative skills with attention to detail

- Excellent communication and interpersonal skills

- Ability to manage multiple tasks and meet deadlines in a fast-paced environment

- Proficiency in Microsoft Office Suite

- Proven experience in healthcare credentialing and insurance enrollment 

- Knowledge of healthcare regulations and payor requirements 

We offer a collaborative work environment, opportunities for professional growth, and a comprehensive benefits package.

Requirements

Required Qualifications:

- Bachelor’s degree in a related field, or a combination of education and experience equivalent to a degree.

- At least 4 years of experience in a healthcare setting.

- Minimum of 2 years of experience in medical provider credentialing and enrollment.

Preferred Qualifications:

- Certification as a credentialing specialist (such as AAPC, CPCS, CPMSM, or NAMSS).

- Experience using Compliatric for managing credentialing documents and conducting related audits.