Sr. Manager, Payer Enrollment
Sr. Manager, Payer Enrollment
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Job Description
Job Details
Description
Position Summary:
The Senior Manager Credentialing and Payer Enrollment will lead and manage all aspects of provider credentialing payer enrollment and related compliance activities for United Digestive providers and facilities. The role will focus on ensuring timely accurate and compliant enrollments while optimizing payer participation and streamlining internal processes. The Senior Manager will collaborate closely with internal teams and external stakeholders including payers vendors and regulatory bodies to ensure smooth and efficient operations in a dynamic healthcare environment.
RESPONSIBILITIES:
Duties may include but are not limited to:
Leadership and Team Management:
- Lead and mentor the Credentialing and Enrollment (C&E) team fostering a high-performance culture focused on accountability development and compliance.
- Oversee recruitment performance management and career development of team members conducting regular performance reviews to optimize productivity.
- Establish and maintain SOPs and KPIs for team.
Credentialing & Enrollment Management:
- Manage the end-to-end process of provider credentialing enrollment and re-credentialing with government and commercial payers ensuring compliance with regulatory and payer requirements.
- Drive provider enrollment and participation across payer networks (Medicare Medicaid commercial) ensuring timely reimbursement and maximizing network access.
- Collaborate with payer representatives to resolve issues and ensure timely and accurate enrollment maintaining strong relationships with external stakeholders.
- Ensure that credentialing and enrollment processes meet all payer-specific and regulatory requirements including accreditation standards.
Process Improvement & Compliance:
- Continuously improve policies procedures and workflows related to credentialing and enrollment to enhance efficiency and reduce errors.
- Stay informed on industry trends and regulatory updates (e.g. NCQA URAC CMS) to ensure ongoing compliance.
- Conduct audits address discrepancies and implement corrective actions to ensure compliance with internal and external requirements.
Vendor & System Management:
- Manage relationships with credentialing vendors ensuring adherence to performance metrics and service-level agreements (SLAs).
- Oversee the administration and optimization of credentialing software (e.g. Verity Credential Stream) to improve efficiency and compliance.
Collaboration & Cross-Functional Support:
- Collaborate with internal teams (e.g. Revenue Cycle Legal Operations) to align efforts and ensure effective credentialing and payer enrollment.
- Provide subject matter expertise on payer policies credentialing guidelines and network participation to support contract negotiations and business development.
- Coordinate with payer relations and contract management teams to resolve issues and ensure timely contract execution.
Strategic Initiatives & Reporting:
- Lead key projects such as provider onboarding TIN changes and Change of Ownership (CHOW) transactions ensuring compliance with payer and regulatory guidelines.
- Generate and analyze credentialing and enrollment metrics providing insights to leadership for data-driven decision-making.
Quality Assurance & Risk Management:
- Ensure adherence to all relevant federal and state regulations payer requirements and internal policies related to credentialing and payer enrollment.
- Proactively identify and mitigate risks associated with provider credentialing payer relationships and compliance.
Qualifications
REQUIRED EDUCATION SKILLS & EXPERIENCE:
Bachelors degree in business healthcare or related filed and 4-6 years of progressive experience in credentialing and provider enrollment strongly preferred. 10 years of credentialing/enrollment and/or revenue cycle management experience may be substituted in place of a degree.
Working knowledge of credentialing and enrollment software preferred ideally Verity Credential Stream. Subject matter expertise in all aspects of provider credentialing and enrollment including knowledge of regulatory & compliance standards credentialing processes commercial and government insurance enrollment and medical staff privileging. Advanced knowledge of healthcare revenue cycle management preferred. Must be proficient in Microsoft Office suite. Strong communication skills from team level to peer level to C-suite level required.
ADDITIONAL SKILLS AND EXPERIENCE:
The Senior Manager must have:
Excellent verbal presentation and written communication skills
Always provide a high level of customer service
Plan prioritize and complete multiple tasks as delegated
Work under pressure; assess respond to and communicate issues in a timely manner
Maintain composure and set a professional example for coworkers
Communicate clearly with patients clients and coworkers through the telephone email and in-person
Build positive working relationships with leadership team members and Providers
Interpret and apply appropriate policies and procedures
Be reliable punctual and able to work independently
A professional outgoing warm and helpful attitude
Required Experience:
Manager
Employment Type
Full-Time
