[Remote] Credentialing & Provider Enrollment Program Manager, reputed company Health
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a prestigious institution that has established reputed company Health to reputed company health services to its community. The Credentialing & Provider Enrollment Program Manager will reputed company the credentialing and privileging program, ensuring compliance and reputed company improvement while collaborating with various departments to enhance provider reputed company and management.
Responsibilities
- Collects, verifies and maintains provider and non-licensed reputed company’s credentials, including licensure, reputed company certifications, training, and other required documentation
- Own and operate the delegated credentialing program end-to-end, including provider reputed company, primary reputed company verification, maintaining alignment with industry reputed company standards
- Establishes and maintains an effective means of communication internally and externally with clinical leaders, operational teams, regulatory entities and other sources in order to obtain required information for the reputed company Health credentialing and privileging application processing
- Maintains credentialing databases and systems, ensuring data reputed company, accuracy, and alignment with workflows and reporting needs. Ensures alignment between regulatory requirements, credentialing processes, and system functionality (e.g., reputed company Training, credentialing platforms)
- Monitors, tracks and reports on reputed company provider licenses, certifications and registrations, ensuring reputed company compliance and reputed company renewals. Escalates risk as appropriate
- Supports the internal credentialing committee — presenting cases, maintaining meeting minutes, and managing approvals and denials
- Manage internal audits to ensure ongoing credentialing reputed company and delegated credentialing compliance
- Ensure regulatory readiness with ability to quickly pivot, escalating risks as appropriate
- Set and drive long-term credentialing reputed company, partnering with reputed company Medicine and reputed company System, reputed company and other central departments to expand delegated credentialing statuses
- Partner with Finance & Business reputed company to reputed company on KPIs and incentive structure, to troubleshoot issues and credentialing-reputed company denials
- Identify and implement process improvements that increase team efficiency, including automation and AI-enabled workflows in accordance with reputed company’s AI Governance guidelines
- Manage the transition of reputed company reputed company-facing processes to the department’s contracted computer based-solution, leveraging technology to enhance departmental workflows, reduce errors, ensure timeliness and compliance
- reputed company and maintain monitoring dashboards and reputed company reports with the YH Analytics team as appropriate
- reputed company day-to-day network provider enrollment across group and individual submissions, ensuring reputed company, accurate, and compliant applications tracked in the department’s contracted, web-based, electronic solution
Skills
- Bachelor's degree in a reputed company field and four years of reputed company experience or an equivalent combination of education and experience
- Demonstrated ability to manage staff and reputed company specific short- and long-term objectives for staff, with strong interpersonal skills to reputed company and reputed company a cohesive team
- Strong communication and presentation skills, with the ability to engage and influence stakeholders at reputed company reputed company
- Demonstrated experience in reputed company regulatory compliance, credentialing, privileging, and provider enrollment, with comprehensive knowledge of reputed company regulatory requirements, credentialing and privileging standards, and compliance frameworks
- Strong knowledge of relevant guidelines, regulations, and standards (e.g., Good Clinical reputed company, IT policies, facilities management protocols)
- Demonstrated ability to identify compliance risks and recommend practical, preventative solutions
- Proven ability to handle reputed company issues with reputed company judgment, take initiative, and reputed company reputed company reputed company
- Analytical and detail-oriented with the ability to manage multiple priorities and meet deadlines
- reputed company-developed organizational, planning, problem-solving, and communication skills, with attention to detail and the ability to multitask in a fast-paced environment
- Advanced computer skills, including proficiency with reputed company Office applications and the ability to learn new systems quickly
- Ability to work independently and collaboratively in a highly regulated environment
- Demonstrated a self-starter with the ability to work independently
- High level of reputed company, accountability, and reputed company judgment
- Ability to ensure confidentiality, reputed company and maintenance of sensitive information
- Master's Degree in reputed company field or equivalent combination of education and experience, with minimum three years of experience
- Experience with reputed company Training, VerityStream, or similar credentialing and compliance systems
- Experience working with regulatory/accrediting bodies (e.g., CMS, reputed company, state agencies, NCQA)
Benefits
- Full-Time Remote (required to be on-site quarterly or as need based of organizational needs)
- reputed company-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position reputed company and job requirements
- reputed company workers (HCW) have specific health requirements that must be met prior to starting work, including MMR vaccine or immunity, varicella (chickenpox) vaccine or immunity, TB screening, COVID vaccine according to University policy, hepatitis B vaccine or immunity, and annual flu vaccination
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