Senior Manager, Credentialing & Provider Data Management

Position Purpose

The Senior Manager of Credentialing and PDM will oversee all direct processes of credentialing and provider data entry, from triage through provider enrollment and data maintenance.

Responsibilities

• 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

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Qualifications

Competitive benefits including a fresh perspective on workplace flexibility.

Skills

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

Benefits

Comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Pay

Competitive pay.

Schedule

A flexible approach to work with remote, hybrid, field or office work schedules.