About this role
Manage day-to-day credentialing and payer enrollment operations, including provider licensing, expiring document tracking, and reporting. Lead a credentialing team through tools, training, policies, and audit coordination while communicating between frontline staff and leadership.
Key Responsibilities
- Manage credentialing and payer enrollment workflows
- Maintain and report from the credentialing database
- Ensure expiring licenses and documentation remain current
- Monitor payer enrollment application turnaround times
- Coordinate credentialing audits and team training/policy enforcement
Technical Overview
The technical scope is operational healthcare credentialing systems and administrative workflows: maintaining an internal credentialing database, ensuring NPPES and PECOS account coverage for providers, and producing reporting while monitoring turnaround times for payer enrollment applications.
Ideal Candidate
The ideal candidate is a mid-level Credentialing Manager with experience running daily credentialing and payer enrollment operations in a Revenue Cycle Department. They are skilled in provider licensing workflows and maintaining accurate credentialing databases, including NPPES and PECOS account management, and can monitor turnaround times and KPI performance.
Must-Have Skills
CredentialingPayer enrollmentProvider licensingNational Plan and Provider Enumeration System (NPPES) account managementProvider EnrollmentChain and Ownership System (PECOS) account managementInternal credentialing database accuracy and reportingMonitoring turnaround timesCoordinating credentialing auditsFacilitating bi-directional communication
Nice-to-Have Skills
Familiarity with credentialing reporting requirementsExperience coordinating electronic copies of credentialing documents
Tools & Platforms
National Plan and Provider Enumeration System (NPPES)Provider EnrollmentChain and Ownership System (PECOS)Internal credentialing database
Required Skills
Credentialingpayer enrollmentprovider licensingNational Plan and Provider Enumeration System (NPPES)Provider EnrollmentChain and Ownership System (PECOS)credentialing databaseturnaround timesreportingcredentialing auditsDEA registrationmalpractice coverage
Hard Skills
CredentialingPayer enrollmentProvider licensingProvider re-appointmentProvider documentation managementNational Plan and Provider Enumeration System (NPPES)Provider EnrollmentChain and Ownership System (PECOS)Expiring documents trackingTurnaround time (TAT) monitoringDatabase managementCredentialing audits coordinationReportingElectronic document maintenanceState licenses managementBoard certification trackingDEA registrationMalpractice coverage trackingCSR (LA only) certificates managementWorking with APRNsWorking with PAs (Physician Assistants)Working with physiciansRevenue Cycle Department operationsKPI monitoringPolicy and procedure coordinationInternal credentialing database accuracy
Soft Skills
LeadershipTrainingBi-directional communicationCustomer-focused mindsetProblem resolutionCost-effective approachTeam management
Keywords for Your Resume
Credentialing Managercredentialingpayer enrollmentprovider licensingre-appointmentexpiring documentsNational Plan and Provider Enumeration System (NPPES)Provider EnrollmentChain and Ownership System (PECOS)APRNsPAsphysicianscredentialing auditsturnaround timesKPI’scredentialing databasereportingstate licensesBoard certificationDEA registrationmalpractice coverageCSR (LA only)Revenue Cycle Departmentpolicies and proceduresCredentialing
Deal Breakers
Must have experience with National Plan and Provider Enumeration System (NPPES) and Provider Enrollment, Chain and Ownership System (PECOS), Must demonstrate experience managing provider licensing and payer enrollment workflows
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