Manager Provider Credentialing & Enrollment

The Manager of Provider Credentialing & Enrollment is responsible for the operational leadership oversight and optimization of Deaconess Health Systems provider credentialing verification provider enrollment and facility enrollment functions. This position leads teams responsible for primary source verification provider data integrity payer enrollment revalidation and ongoing monitoring activities that support provider readiness regulatory compliance and reimbursement.

The Manager ensures providers and facilities are credentialed enrolled and maintained in accordance with applicable regulatory accreditation and payer requirements. The position works closely with Medical Staff Services Revenue Cycle Managed Care Physician Recruitment Practice Operations Compliance and Health System leadership to support seamless provider onboarding and uninterrupted reimbursement.

• Lead provider credentialing activities for physicians APPs and other practitioners.
• Ensure timely and accurate primary source verification.
• Oversee licensure board certification sanctions exclusions malpractice and ongoing monitoring.
• Maintain audit-ready credentialing records.
• Monitor KPI reporting for turnaround times and quality metrics.

• Lead Medicare Medicaid managed care and governmental payer enrollment activities.
• Oversee initial enrollments revalidations provider updates ownership changes and terminations.
• Ensure providers and facilities are enrolled timely to prevent reimbursement delays.
• Monitor payer enrollment performance and aging metrics.

• Maintain provider demographic credentialing and enrollment data across enterprise systems.
• Support provider data governance initiatives.
• Collaborate with Revenue Cycle HR Information Systems and Medical Staff Services.

• Ensure compliance with CMS ACHC NCQA state regulations and payer requirements.
• Support internal and external audits and accreditation reviews.
• Oversee exclusion screening and sanction monitoring processes.
• Create update and enforce credentialing enrollment policies.

• Lead and develop credentialing and enrollment staff.
• Establish and maintain productivity quality and service expectations.
• Drive process improvement automation and standardization initiatives.

• Bachelors degree required; Masters degree preferred.
• Five years of credentialing enrollment medical staff services provider operations or revenue cycle experience.
• Three years of leadership experience preferred.
• CPCS CPMSM or CPES certification preferred; if not currently certified must obtain one of these credentials within three years of hire.

Required Experience:

Manager