Credentialing & Enrollment Manager (Remote)
Core
Lead provider credentialing, payer enrollment, and contracting operations across multiple states and payer networks for a healthcare services organization.
Role type
Senior operational manager (credentialing & enrollment)
Builds
Provider enrollment projects and payer network access
Domain
Healthcare administration and insurance operations
Deliverable
client delivery
Required skills
Medicare enrollment, Medicaid enrollment, commercial payer credentialing, CAQH management, PECOS management, NPPES management, Availity platform usage, provider contracting, multi-state enrollment management, team leadership, workflow optimization, compliance management
Preferred skills
Remote team management, physician/behavioral health/facility credentialing experience, CRM/credentialing software proficiency
Technologies
CAQH, PECOS, NPPES, Availity
Responsibilities
Manage end-to-end provider credentialing and enrollment processes, oversee Medicare/Medicaid/Commercial Insurance enrollments, track credentialing status and maintain provider records, coordinate with providers and payers, handle recredentialing and demographic updates, monitor enrollment timelines, develop and improve credentialing workflows, lead and mentor credentialing specialists, prepare credentialing reports and performance metrics
Seniority
Senior, hands-on IC with leadership responsibilities