Provider Enroll & OnBoardg Mgr

Responsibilities

• Develops and implements communication strategy to accurately update and maintain all internal systems and resources with appropriate provider and network participation information.
• Communicates provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for professional services rendered.
• Accurately completes or provides for the completion of the enrollment/reenrollment processes as outlined by each payer for all appropriate healthcare providers to ensure timely and continued provider network participation.
• Manages group level credentialing, contracting and enrollment processes with third party and governmental payers, e.g., reporting of group practice changes to Medicare via 855B updates, Medicaid re-enrollments, working with new payer contracts to enroll group/providers.
• Participate in regular practitioner recruitment, onboarding and offboarding committees as lead resource for payer credentialing function. Provide necessary reports and updates to these committees.
• Troubleshoots concerns throughout the onboarding process and works with multi-disciplinary practice personnel to find appropriate solutions to ensure timely completion of tasks.
• Works closely with internal constituents and Senior Leadership to continually develop the onboarding program and assess for effectiveness.
• Lead report development and management for payer credentialing functions, including designing, maintaining, and continuously improving dashboards and operational reports to monitor performance, volume, and outcomes.
• Manage and enforce timelines and due dates for all credentialing activities, including initial enrollments, revalidations, re-credentialing, and payer updates, ensuring compliance with internal SLAs and external payer requirements.
• Implement and maintain robust tracking systems to monitor credentialing status across all payers, ensuring transparency, data accuracy, and timely escalation of issues or delays.
• Analyze workflow metrics and trends to identify process improvement opportunities, optimize turnaround times, and enhance overall team efficiency.
• Collaborate with cross-functional teams (e.g., contracting, compliance, operations) to ensure credentialing data integrity and alignment with business needs.
• Prepare and deliver regular operational reports to leadership, summarizing productivity, backlog, aging, and key performance indicators (KPIs).
• Ensure compliance with regulatory, payer, and organizational standards within all credentialing processes.

  Human Resources/Personnel Management

  • Supervise credentialing and enrollment staff including recruiting, training, evaluating and monitoring quality of work and productivity of the department.
  • Establishes work schedules and ensures appropriate resources to complete work within established guidelines.
  • Maintains and enforces policies and procedures related to third party enrollment, provider licensure and credentials, compliance and the overall revenue cycle.
  • Ensures employees are familiar with, have access to, and comply with policies, procedures, reference materials which conform to current regulatory requirements.
  • Arranges for staff to attend internal and external education as needed.
  • Keeps informed regarding current regulations, insurance company policies, professional standards and company/department policies and procedures and effectively applies this knowledge.

  Policies and Procedures

  • Responsible for the research, development, implementation, maintenance of and compliance with policies, procedures, and guidelines related to third party enrollment, provider licensure and credentials, compliance and the overall revenue cycle.
  • Assures employees are familiar with, have access to, and comply with policies, procedures, reference materials which conform to current regulatory requirements.
  • Arranges for staff to attend internal and external education as needed.
  • Keeps informed regarding current regulations, insurance company policies, professional standards and company/department policies and procedures and effectively applies this knowledge.