Manager, Network Integrity

Cardinal Health

4d•$105,100 - $135,090•Onsite

About The Position

The Manager of Network Integrity is a critical leadership role responsible for steering the credentialing, compliance, and Medicaid growth strategy for our DMEPOS operations. This position oversees the end-to-end credentialing lifecycle, balancing day-to-day operational excellence with overarching strategic initiatives. A vital part of this role involves serving as our in-house expert on Medicaid policy, researching and interpreting administrative billing requirements to ensure seamless reimbursement. Furthermore, the Manager of Network Integrity will spearhead our strategy to expand our Medicaid Fee-for-Service (FFS) and Managed Care footprint, acting as the crucial connective tissue bridging our Network Management and Revenue Cycle teams.

Requirements

Bachelor's degree or equivalent experience preferred.
5+ years of experience in credentialing, network management, or provider enrollment, with a strong preference for candidates who have managed these processes within the Durable Medical Equipment (DME), Home Medical Equipment (HME), or DMEPOS industry strongly preferred.
Relevant experience in the payer space a plus.
Proven leadership experience with a demonstrated ability to coach, mentor, and develop others.
Must possess a strong "player-coach" mentality—capable of guiding strategic initiatives and empowering team members while remaining willing to roll up your sleeves and support day-to-day credentialing operations.
Proven ability to design, build, and execute a comprehensive strategic roadmap for credentialing operations and network footprint expansion that aligns with overarching organizational goals.
Strong analytical capabilities with a demonstrated ability to analyze complex operational metrics and synthesize them into clear, actionable insights and strategic recommendations for executive leadership.
Exceptional written, verbal, and presentation skills, with experience presenting complex operational and regulatory strategies to senior leadership, cross-functional partners, and external stakeholders.
Deep subject matter expertise in Medicaid policy and administrative guidelines, with a proven track record of effectively researching, interpreting, and applying state-specific Medicaid billing and enrollment requirements.
Proven success in spearheading network growth strategies, specifically demonstrating experience in expanding Medicaid Fee-for-Service (FFS) and Managed Care Organization (MCO) footprints across multiple markets or states.
Comprehensive knowledge of federal and state healthcare compliance standards, accreditation guidelines and quality assurance related to provider credentialing and network integrity.

Responsibilities

Oversee and direct all day-to-day credentialing, re-credentialing, and enrollment activities for the organization, ensuring accuracy and timely completion.
Develop, implement, and continuously refine the overarching credentialing strategy to align with the company's growth objectives and operational capabilities.
Maintain a robust quality assurance process for all credentialing files and provider databases to ensure audit-readiness and compliance with state, federal, and payer-specific standards.
Optimize internal reporting mechanisms to ensure credentialing and network data visibility meets the specific needs of various internal stakeholders, including Legal, Compliance, and Revenue Cycle Management.
Continuously research, monitor, and interpret Medicaid policies, manuals, and bulletins across various states and jurisdictions. Stay up-to-date on all administrative requirements necessary for clean claim submission and billing compliance.
Translate complex regulatory changes into actionable operational guidelines for internal teams to prevent claim denials and ensure revenue integrity.
Lead the strategic planning and execution efforts to grow the company's Medicaid Fee-for-Service and Managed Care organization footprint.
Identify new market opportunities and guide the team through the application and contracting processes required to enter new networks.
Partner with leadership to assess the financial and operational viability of entering new Medicaid markets.
Serve as the primary liaison connecting internal dots between the Network Management, Contracting, Revenue Cycle (RCM), and Market Access Sales departments.
Proactively collaborate with RCM leaders to troubleshoot front-end credentialing issues that impact back-end billing and cash flow.
Lead cross-functional meetings to ensure all stakeholders are aligned on network status, risk updates, and process improvements that affect the organization's bottom line.