Senior Manager, Credentialing & Provider Data Management

Role Overview

• Oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance
• Direct oversight for credentialing and re-credentialing of all physicians, mid-level practitioners and organizational providers
• Oversee all activities related to the management of provider data, including the development and management of training materials, policies, and procedures
• Ensure updates (adds, changes, and terminations) for new or existing provider records are made in accordance with health plan policies and state/federal regulations
• Ensure compliance with key performance indicators established by corporate office, NCQA credentialing standards, and state/federal requirements
• Manage updates to and production of hard copy and online provider directories
• Ensure accuracy of provider enrollment specifications and specialty types and demographics

Requirements

• Bachelor’s degree or equivalent experience
• 4 years of relevant experience
• NCQA, credentialing, and provider data management knowledge required
• 3+ years of supervisory/management experience
• Preferred experience with Portico, Amisys, CenProv

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules