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Project Manager - National Credentialing & Payer Enrollment
Revenue Cycle Management
Remote - US
Full Time

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Title/Position: Project Manager - National Credentialing & Payer Enrollment

Department or Business Unit: Credentialing and Enrollment

Reporting Structure: Senior Director, National Credentialing & Payer Enrollment

Employment Type: FTE

Exemption Status: Exempt

Min. Experience: Mid-Level

Travel Required: Some


Overview of the Role:


Reporting to the Senior Director, National Credentialing & Payer Enrollment, the Project Manager of National Credentialing & Payer Enrollment will focus on partnering with the National Credentialing & Payer Enrollment Leadership Team to operationalize identified process improvement needs. This individual will help to advance projects focusing on key elements of change such as; policies & procedures, technology, people in credentialing & enrollment roles, and structure. In between special projects this individual will work within all aspects of credentialing and enrollment to help meet deadlines and cover gaps wherever assistance may be needed within National Credentialing and all payer enrollment markets. 


Essential Functions:


  • Serve as liaison between leadership team and National Credentialing & Payer Enrollment markets to assist and coach in day to day processes and process improvement as needed
  • Helps to create and foster a culture of customer service within the markets to better serve care centers and all stakeholders
  • Effectively collaborate with and serve as an additional point of contact for credentialing and enrollment stakeholders including Revenue Cycle, Implementation, Contracting, Performance, & administrative staff
  • Collect, monitor, and analyze enrollment and credentialing data relative to established goals and metrics to identify potential risk and/or areas of opportunity and prepare action plans for improvement with the support and assistance of leadership
  • Organize and execute task force / special teams as needed to partner in operationalizing initiatives identified by National Credentialing & Payer Enrollment leadership team 
  • Work with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
  • Oversee special projects requiring knowledge of NCQA, CMS & State regulatory standards as well as our delegated and non-delegated health plan requirements
  • Interact with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation, provider maintenance and launch
  • Project Manager is responsible for all audits to ensure that delegated credentialing entities are compliant as well as seeking delegation for other existing contracts
  • Perform other duties as assigned based on National Credentialing or Payer Enrollment market need
  • Exercise independent judgment in interpreting NCQA, Joint Commission, URAC, CMS and State Laws and regulations as they pertain to the credentials of PMG Providers


Minimum Qualifications:


  • 5-10 years experience in managed care credentialing, billing and/or Medical Staff service setting required
  • Experience managing people preferred
  • Demonstrated skills in problem solving and analysis and resolution
  • Must be able to function independently, possess demonstrated flexibility in multiple project management
  • Must comply with HIPAA rules and regulations

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