Manager, Network Integrity

Responsibilities

• Oversee and direct all day-to-day credentialing, re-credentialing, and enrollment activities for the organization, ensuring accuracy and timely completion.
• Develop, implement, and continuously refine the overarching credentialing strategy to align with the company's growth objectives and operational capabilities.
• Maintain a robust quality assurance process for all credentialing files and provider databases to ensure audit-readiness and compliance with state, federal, and payer-specific standards.
• Optimize internal reporting mechanisms to ensure credentialing and network data visibility meets the specific needs of various internal stakeholders, including Legal, Compliance, and Revenue Cycle Management.
• Translate complex regulatory changes into actionable operational guidelines for internal teams to prevent claim denials and ensure revenue integrity.
• Lead the strategic planning and execution efforts to grow the company's Medicaid Fee-for-Service and Managed Care organization footprint.
• Identify new market opportunities and guide the team through the application and contracting processes required to enter new networks.
• Partner with leadership to assess the financial and operational viability of entering new Medicaid markets.
• Serve as the primary liaison connecting internal dots between the Network Management, Contracting, Revenue Cycle (RCM), and Market Access Sales departments.
• Proactively collaborate with RCM leaders to troubleshoot front-end credentialing issues that impact back-end billing and cash flow.
• Lead cross-functional meetings to ensure all stakeholders are aligned on network status, risk updates, and process improvements that affect the organization's bottom line

Qualifications

• Bachelor's degree or equivalent experience preferred.
• 5+ years of experience in credentialing, network management, or provider enrollment, with a strong preference for candidates who have managed these processes within the Durable Medical Equipment (DME), Home Medical Equipment (HME), or DMEPOS industry strongly preferred.
• Relevant experience in the payer space a plus.
• Proven leadership experience with a demonstrated ability to coach, mentor, and develop others. Must possess a strong "player-coach" mentality—capable of guiding strategic initiatives and empowering team members while remaining willing to roll up your sleeves and support day-to-day credentialing operations.
• Proven ability to design, build, and execute a comprehensive strategic roadmap for credentialing operations and network footprint expansion that aligns with overarching organizational goals.
• Strong analytical capabilities with a demonstrated ability to analyze complex operational metrics and synthesize them into clear, actionable insights and strategic recommendations for executive leadership.
• Exceptional written, verbal, and presentation skills, with experience presenting complex operational and regulatory strategies to senior leadership, cross-functional partners, and external stakeholders.
• Deep subject matter expertise in Medicaid policy and administrative guidelines, with a proven track record of effectively researching, interpreting, and applying state-specific Medicaid billing and enrollment requirements.
• Proven success in spearheading network growth strategies, specifically demonstrating experience in expanding Medicaid Fee-for-Service (FFS) and Managed Care Organization (MCO) footprints across multiple markets or states.
• Comprehensive knowledge of federal and state healthcare compliance standards, accreditation guidelines and quality assurance related to provider credentialing and network integrity.

Pay & Benefits

Anticipated salary range: $105,100 - $135,090
Bonus eligible: Yes
Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being.
- Medical, dental and vision coverage
- Paid time off plan
- Health savings account (HSA)
- 401k savings plan
- Access to wages before pay day with myFlexPay
- Flexible spending accounts (FSAs)
- Short- and long-term disability coverage
- Work-Life resources
- Paid parental leave
- Healthy lifestyle programs