Manager, Provider Credentialing and Enrollment.

Midwest Vision Partners - Brecksville, OH

Full-time - Mid Level

Brecksville, OH

Ambulatory Health Care Services

About the position

The Manager of Provider Credentialing and Enrollment is a key role within the Revenue Cycle Management team, responsible for overseeing all activities related to provider credentialing, enrollment, and payer relations. This position ensures that processes are completed timely and effectively, collaborating with leadership and providers across various healthcare sectors including Optical, Ophthalmology, and Surgical Centers. The manager will lead a team, develop policies and procedures, and maintain compliance with regulatory requirements.

Responsibilities

• Manage the timely and accurate provider systems enrollment processes for employed practitioners, including initial enrollment, re-enrollment, re-validations, terminations, and updates to provider and/or payor records.
• Facilitate standardization, integration, and operational continuity in collaboration with MVP leadership.
• Coordinate the development of system-wide policies and procedures, action plans, workflows, and audit reports related to Provider Enrollment.
• Maintain viable contacts with payers and plans, staying abreast of regulatory requirements and changes.
• Collaborate with operations to ensure that all provider-related documentation is maintained in a shared location.
• Communicate the status of new provider enrollment and existing provider revalidations with Regional Directors of Operations.
• Complete all Group and Facility enrollment, reappointments, revalidations, and various carrier requests.
• Maintain Certificate of Insurance for all Providers and Groups on an annual basis.
• Research and implement new state enrollment as well as changes to current state enrollment.
• Maintain CAQH for all providers, including logins and passwords.
• Assist in maintaining provider licensure and communicate enrollment changes to ensure accurate scheduling.
• Provide leadership to the Credentialing/Provider Enrollment team and conduct annual performance reviews.
• Establish operating cadence and meetings with the team, identifying training needs and skill development opportunities.
• Communicate effectively with all stakeholder groups to review performance and discuss issues impacting financial performance.

Requirements

• Bachelor's degree in finance or business-related field or commensurate experience.
• 5+ years in healthcare or related industry experience.
• 3+ years supervisory experience or as a manager.
• Exemplary working knowledge of provider and payer enrollment activities along with Revenue Cycle Management.
• Excellent written and verbal communication skills.
• Highly organized, dependable, and focused on quality and service.
• Self-directed, metrics-minded, and unafraid of challenging the status quo.
• Demonstrated teamwork skills and the ability to work with different teams and entities.
• Experience developing strategic initiatives that align with business objectives and key priorities.
• Proficiency using Microsoft Office, such as Outlook, Word, Excel, and PowerPoint.
• Knowledge of the EMR and Practice Management system is a plus.
• High ethical standards.