Manager, Payor Credentialing

Job Summary:

The Manager of Payer Credentialing is responsible for working on the day-to-day requirements of Payer Credentialing and Enrollments. This role requires a strong self-motivated work ethic, the ability to determine without guidance what needs to be worked on and prioritized, a deep understanding of payor enrollment, credentialing, re-credentialing, healthcare operations, change management, and the ability to implement processes. The Manager will partner with the team lead to focus on optimizing revenue, standardizing processes, building and maintaining strong payer relationships, and ensuring positive internal and external client experiences.

Essential Responsibilities/Duties:

● Holding a major role of responsibility with a high-performing payer credentialing team, fostering a culture of accountability, collaboration, and continuous improvement.

● Continuously evaluate and improve existing payer enrollment processes and systems, leveraging technology, vendors, and best practices to enhance quality and productivity.

● Monitor industry trends and regulatory changes to proactively adjust processes and ensure continued compliance.

● Comply with all State and Federal Laws regarding an effective Compliance Program, inclusive of HIPAA Privacy and Security.

● Adhere to the organization's Code of Conduct and be familiar with all compliance policies and procedures relevant to this position.

● Hold oneself accountable for completing all activities in a timely manner

Qualifications:

* Education:

- Bachelor's degree, required.

* Competencies/Skills:

- Demonstrated success in credentialing..

- Exceptional problem-solving skills and the ability to think strategically and execute operational initiatives.

- Strong communication, interpersonal, and leadership skills, with the ability to effectively manage cross-functional relationships.

- Proven track record in managing provider data management systems, client, and payer relationships.

* In-depth knowledge of credentialing processes, regulatory requirements, and healthcare industry standards.

* Experience:

* 5-7 years of Credentialing Management experience in a managed care or healthcare environment. Laboratory credentialing experience is required.

* Proficiency with MS Office, Adobe Acrobat, Google Workspace, and Salesforce applications. Monday.com, and Smartsheet software knowledge is a plus.

This job description is intended to outline the general nature and key responsibilities of the role. It is not an exhaustive list of all duties, responsibilities, or qualifications associated with the position. Responsibilities may evolve, and additional tasks may be assigned as business needs change, with or without prior notice.