Credentialing and Enrollment Manager II

It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. Summary • *Knowledge of Medallion System Preferred** The Credentialing and Enrollment Manager II will oversee the processing of applications and reapplications for medical staff and allied health professionals to ensure compliance with national accreditation standards and state and federal regulatory requirements. Description • Manage vendor relationships and drive continuous improvement in operational performance. • Collaborate with Credentialing and Enrollment Manager I to resolve bottlenecks in internal systems through effective project management, prioritization of tasks, and strong analytic skills. • Develop and implement policies and procedures for the credentialing and re-credentialing process, ensuring they meet industry standards and organizational needs. • Manage the primary source verification of education, training, board certification, work history, and licensure of healthcare providers. • Coordinate the review and analysis of credentialing information, presenting findings to the credentials committee for decision-making. • Facilitate the resolution of discrepancies or concerns regarding applicants' credentials, working closely with medical staff leadership and healthcare providers. • Maintain accurate and confidential credentialing databases and files, ensuring the security and integrity of sensitive provider information. • Liaise with external agencies, including insurance carriers and regulatory bodies, to ensure the timely sharing of credentialing information and compliance with external standards. • Assist the accounts receivable department with credentialling related payor denials. • Maintains CMS NPPES reporting. • Manages and reports operational metrics. Monitors and manages turnaround times for processing of credentials applications and has overall accountability for focus on delivery of a high-quality product, with the greatest efficiency, in the least amount of time. • Oversee the auditing of credentialing processes and documentation to identify areas for improvement and ensure adherence to accreditation standards and best practices. • Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing. • Manage payer enrollment process for the company and all providers. Qualifications • Minimum of five (5) years of progressively responsible operational or consulting experience in provider credentialing and enrollment in an outpatient setting. • Medallion system experience preferred. • Knowledge and experience of the healthcare industry or medical financial operations. • Possess ability to identify patterns and conduct root cause analysis. • Maintain accurate and up-to-date provider credentialing information in the database. • Experience with CAQH (Council for Affordable Quality Healthcare) database and application process. • Strong attention to detail and organizational skills. Demonstrated ability to manage multiple, concurrently running projects and adapt to changing deadlines, competing priorities and unexpected assignments. If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us! EEO Statement PM Pediatric Care is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status or any other characteristic protected by law. Apply Job!