Senior Manager, Provider Enrollment & Credentialing

Description

Core Clinical Partners stands at the forefront of Emergency and Hospital Medicine, delivering unparalleled services through a model that emphasizes patient-centric care and operational excellence. Our corporate values – Genuine, Accountable, Dynamic, Respectful, and Fun – are the pillars that uphold our commitment to revolutionize healthcare delivery.

The Senior Provider Enrollment Manager is responsible for leading our Clinician Enrollment and Credentialing departments. This critical role will be responsible for managing both the processes related to the enrollment of healthcare providers with payers and healthcare networks and the credentialing processes at partner hospitals. This role requires strong leadership skills, attention to detail, and the ability to drive process improvements.

The Senior Manager will work closely with internal stakeholders, including operations, compliance, revenue cycle accounts receivable team, network management teams, and hospital partners to ensure that all clinician data is accurately maintained and in compliance with regulatory requirements. This role will have a shared reporting relationship through Revenue Cycle Management (RCM) and Operations. Strong leadership skills, attention to detail, and the ability to drive process improvements within the provider enrollment function.

This position is a hybrid position and open to candidates either in Atlanta, GA or Lafayette, LA.

Essential Duties

Leadership & Team Management:

• Lead, mentor, and manage the provider enrollment and credentialing team(s), ensuring high performance and efficient workflows.
• Set clear performance objectives, provide training, and conduct regular performance reviews.
• Utilize data analytics to monitor performance metrics and make informed decisions.
• Foster a collaborative and positive team environment to promote growth and retention.
  
  

Provider Enrollment

• Oversee the end-to-end process for the enrollment of clinicians with payers, ensuring all providers are fully enrolled in a timely manner.
• Identify opportunities to streamline and enhance provider enrollment processes, reducing cycle time and improving overall efficiency.
• Work with cross-functional teams to develop and implement policies and procedures that support provider enrollment goals.
• Implement and manage technology solutions that improve the enrollment process, including provider data management systems.
• Ensure that all provider demographic, credentialing, and contract information is accurate and compliant with internal and external requirements, ongoing.
• Maintain detailed clinician enrollment files in electronic format, including electronically received documents, scanning of hard copy documents and documents each state of the enrollment/re-enrollment process thoroughly.
• Develop and maintain relationships with external regulatory bodies (e.g., CMS, state Medicaid programs, commercial payers) to ensure compliance with all applicable rules and regulations.
• Facilitate resolution or provider related denials to ensure appeal procedures are followed to result in proper reimbursement.
• Develop and maintain policies and procedures to support compliance and operational efficiency.
  
  

Credentialing

• Oversee and manage the Hospital Credentialing team
• Ensure timely and accurate credentialing and re-credentialing of all providers in compliance with the hospital bylaws.
• Maintain up-to-date knowledge of all credentialing requirements and regulations that govern hospital credentialing.?
• Ensure integrity of clinician data within systems (Salesforce)
• Develop tracking of crucial credentialing items such as licensure, required continuing education, and other items required by various medical staff offices at various clients.?
• Develop and maintain policies and procedures to support compliance and operational efficiency.
  
  

Compliance & Risk Management

• Ensure that provider enrollment and credentialing activities comply with all federal, state, payer, and hospital regulations, including HIPAA, CMS guidelines, and other healthcare industry standards.
• Act as the primary point of contact for internal and external audits related to provider enrollment.
• Conduct regular audits to ensure the integrity of credentialing and enrollment data and processes.
• Stay current on hospital credentialing regulatory changes and works towards improved timing of clinician hospital credentialing with quality clinician experience.
  
  

Reporting & Analytics

• Monitor and report on provider enrollment goals and OKRs, including provider enrollment cycle times, accuracy, and completion rates.
• Prepare regular status updates and reports for senior leadership on enrollment progress and key challenges.
• Provide assistance with ongoing quality initiatives related to improved data processing and workflows. Keeps current regarding any changes in managed care payor requirements for clinician enrollment and participates in ongoing training sessions.?
  
  

Cross-Functional Collaboration

• Work closely with the RCM and Operations to align enrollment and credentialing processes with organizational goals.
• Work closely with the contracting, credentialing, network management, and compliance teams to ensure seamless provider onboarding experience.
• Collaborate with customer service teams to address provider-related inquiries and resolve issues promptly.
• Serve as a subject matter expert on provider enrollment for internal teams and external stakeholders.
• Participate in cross-departmental projects and initiatives to enhance overall company performance.
• Perform other duties as assigned
  
  

Requirements

Skills, Knowledge, Abilities:

• In-depth knowledge of hospital credentialing and clinician payor enrollment processes.
• Strong leadership and team management skills.
• Ability to manage a remote workforce.
• Ability to analyze data and generate actionable insights.
• Strong problem-solving skills with a proactive approach to challenges.
• Exhibit growth mindset and team-orientated behaviors
• Utilize independent judgment on determining areas of collaboration, escalation, and autonomy?
• Collaborate with professionals internal and external to the company and across geographic locations
• Knowledgeable on credentialing requirements and workflows for providers at differing client groups
• Excellent verbal and written communication skills
• Excellent interpersonal and customer service skills
• Excellent organizational skills and attention to detail
• Navigate competing priorities and effectively work in a fast-paced environment
• Manage information flow in a timely and accurate manner
• Proficient in Microsoft Office Suite and credentialing related software
  
  

Education

• Bachelor’s degree in healthcare administration, Business, or a related field required.
• Master’s degree preferred.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.
  
  

Experience

• Minimum of 7 years of experience in clinician hospital credentialing and payor enrollment within a healthcare setting.
• At least 3 years of leadership experience managing hospital based credentialing teams and working with Medical Staff Offices.
• Experience working with institutions that have various accrediting bodies such as Joint Commission or DNV.
• Experience working collaboratively across multiple departments.
• Experience with MS Outlook, Word, and Excel