Director of Credentialing & Enrollment

Overview

At Anne Arundel Dermatology we give exceptional care - to our patients and to each other. 

Patient First | Caring | Accountability | Trust | One Team | Growth

Hybrid position- approximately 25% in office at HQ in Central MD for required on site meetings. Strong preference given to candidates who live in MD, S. PA or N. VA. Must live within Eastern time zone. 

The Director of Credentialing & Enrollment will have oversight of the Clinician Credentialing Team. Responsibilities include leading, coordinating, implementing, monitoring and maintaining the clinician credentialing and provider enrollment process. The Director will facilitate all aspects of the clinician credentialing and provider enrollment process. Create standard operating procedures and process improvement initiatives. Clinician Credentialing and Provider Enrollment processes include development of relationships with internal clients, clinicians, and those external clients (third party payers including commercial insurance, managed Medicaid, Government, VA, and other carriers as needed) in an effort to support and further the company in its goals for growth. The Director of Credentialing & Enrollment is also responsible for the integrity and accuracy of information in credentialing software and other system related applications.

Responsibilities

• Manage the development and implementation of new Clinician credentialing.
• Manage the development and implementation of clinician internal credentialing process.
• Maintain credentialing software to ensure data accuracy and integrity of information.
• Track and monitor new credentialing processes maintaining compliance with regulatory, state, federal and accrediting entities.
• Lead credentialing discussions with third party payers, including established processes and new process implementation in accordance with established guidelines.
• Establish and maintain positive working relationship with internal and external clients and clinicians.
• Research various state enrollment policies/procedures to ensure thorough understanding of state requirements.
• Facilitate creation and maintenance of Standard Operating Procedures; department Policies and Procedures; training and resource department materials.
• Audit and review Credentialing Team results and reports including data integrity, accuracy, productivity to discover process improvement opportunities
• Assist with Clinic/Group Medicare enrollment as needed.
• Assist in development of KPIs and metric reports
• Monthly department meetings and coordinator one-on-one (1:1) meetings are scheduled
• Encourage continued educational and professional development of the Credentialing Team
• Working knowledge of payer contracting
• Assists with interviewing and hiring of Credentialing Team
• Travel as needed
• Other duties as assigned

Qualifications

• 7 years of related credentialing or provider enrollment experience required.
• 7 years healthcare experience required.
• Demonstrated knowledge of credentialing and enrollment
• Ability to effectively manage priorities, drive results, and take initiative.
• Strong communication and organization skills
• Demonstrated organizational and project management skills to manage complex projects through effective planning, tracking, and resource allocation to meet business objectives and timeline
• Ability to generate creative solutions, identify the best course of action and rapidly resolve complex issues/problems
• Must be proficient in Microsoft Word, Excel, and PowerPoint.
• NCQA certification experience
• Delegated payer credentialing experience
• Minimum of 3 years supervising experience
• Multi state credentialing experience

Licensure/Certifications/Education

• BA/BS degree required, Professional Certification in area of Credentialing and Provider Enrollment preferred

Full-time employees (defined as regularly working at least 30 hours per week) are eligible for the following benefits:

• Medical, Dental & Vision insurance – effective 1st of the month after date of start
• Short-term and long-term disability, Voluntary life (employee, spouse, and child), Critical Illness, and Hospital Indemnity – Effective the 1st of the month following date of hire
• Company provided Basic Life/AD&D insurance
• Paid time off
• Paid holidays
• Retirement Savings account
• Employee discount on cosmetic services and products

Salary Range: $110,000 - $130,000 Bonus potential

Salary : $110,000 - $130,000