About This Role
This role is for a manager who will own the end-to-end process of onboarding providers and enrolling them with payers. The core challenge is diagnosing and resolving enrollment failures, as well as building robust systems to replace current manual processes. The position suits a persistent and organized individual who can drive improvements and manage timelines effectively.
Responsibilities
- Own onboarding for new providers end to end: collect and verify every document credentialing requires
- Own the chase: follow up on late documents from busy clinicians to prevent onboarding delays
- Keep each provider's document set current and track expiration dates to prevent lapses
- Manage initial enrollment, re-credentialing, and revalidation across Medicare, Medicaid, and commercial payers
- Handle both individual and group enrollment, and link rendering providers to the group entity to ensure claims are paid
- Diagnose enrollment failures rather than just resubmitting them
- Maintain CAQH profiles and an internal master credentialing record covering licenses, certifications, coverage, and expiration dates
- Track effective dates by provider and by payer, and publish status in a form the rest of the company can act on
- Support expansion into new payers and new states
- Call payers directly and persist until reaching someone who can provide answers
- Review and resolve payer contracts, including entity name mismatches, incorrect addresses on file, and effective dates that do not match what was agreed
- Work with billing when a credentialing defect surfaces downstream as a denial, and drive corrected claim resubmission
- Create, own, and continuously improve the systems this function runs on, moving away from spreadsheets, payer portals, and institutional memory
- Work with management to build tracking that shows, at any moment, where every provider stands with every payer, and to surface where the process is stalling
- Find the bottlenecks and remove them, automating what can be automated, standardizing what cannot, and documenting all processes
- Supervise a credentialing specialist
- Give the scheduling team an accurate live picture of which providers can see which patients under which plans
- Communicate directly with providers about enrollment status, including difficult conversations when approvals are slow
Requirements
- Persistent to a fault, refusing to accept the first answer given to solve hard problems
- Comfortable asking a provider for the same document multiple times and successfully obtaining it
- Organized enough to maintain a live picture of dozens of providers across multiple payers and states without losing track
- A builder who identifies and fixes manual processes rather than repeating them
- Coachable and quick to retain specific mechanics taught for the role
- Comfortable owning a number, as performance will be measured on time to enrollment and the number of fully live providers
- Strong written communication for payer correspondence and provider updates
Nice to have:
- Three or more years in provider enrollment and credentialing, with hands-on Medicaid and Medicare experience; multi-state experience is a significant plus
- Fluency in the mechanics: individual versus group NPI, CAQH, PECOS, MCO delegation, revalidation cycles, effective dates, and retroactive billing windows
- Supervisory experience, or clear readiness to supervise
- Comfort with spreadsheets, tracking tools, and process automation
- Broader healthcare administration, revenue cycle, or medical billing background
Benefits
Important Details
If you do not have the background
- Apply anyway; in your application, describe a time you owned a messy problem end to end and persisted until it was fixed.
About the Company
We are hiring a Provider Enrollment and Credentialing Manager to own provider onboarding and payer enrollment end to end.
