Sr. Manager, Payer Enrollment (59221)

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.

REQUIRED EDUCATION, SKILLS & EXPERIENCE:

Bachelor’s 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 c