Manager of Delegated Credentialing & Enrollment

Bassett Healthcare Network • Cooperstown, NY

95d • $74,953 - $112,429

About The Position

Are you looking to make a difference by improving the health of our patients? Here you will find an innovative culture that is patient-focused and dedicated to making a difference. We are committed to helping the population we serve, and our communities, achieve optimum health and enjoy the best quality of life possible. The Manager of Delegated Credentialing and Enrollment oversees all aspects of provider credentialing, recredentialing, and enrollment processes, ensuring compliance with regulatory and accreditation standards. This role manages staff and vendor relationships, maintains systems and databases, and supports cross-functional coordination to optimize provider onboarding and reimbursement workflows. This role ensures timely and accurate submission of applications, manages staff performance, and collaborates with internal departments to support clean claims and regulatory compliance.

Requirements

• 2 Year/Associate Degree, required (concentration in healthcare Degree reimbursement and/or healthcare administration)
• Minimum 5 years of experience in healthcare credentialing and enrollment for physician group practice and facilities, required
• Credentialing Specialist (CPCS) or ability to attain eligibility, preferred
• Skills in organizing/categorizing records, interacting with people, communication, accounting, and computer skills

Responsibilities

• Oversee delegated and non-delegated credentialing and enrollment processes and staff
• Manage oversight of provider rosters and ensure timely updates to payers and internal systems
• Monitor and track provider's expirable documents and ensure timely renewals
• Coordinate onboarding and offboarding of provider processes related to credentialing and enrollment
• Develop and implement provider orientation and annual reviews regarding credentialing requirement
• Ensure compliance with NCQA, TJC, CMS, CAQH, NPPES, and payer-specific standards
• Conduct internal and external audits in accordance with delegated agreements
• Maintain and update credentialing policies and procedures
• Perform quality assurance reviews and support the Quality Improvement Plan
• Manage credentialing databases (e.g., Verity Stream/Credential Stream) and electronic application systems
• Recommend and implement technological solutions to improve departmental efficiency
• Oversee the submission of provider data to IT for system updates and reimbursement processing for accuracy
• Lead coordination with Information Technology to maintain synchronization across provider databases and interfaced applications
• Ensure timely communication of provider status changes to internal departments and payers
• Represent the organization professionally in internal and external forums
• Conduct performance appraisals and develop standards of performance
• Support staff development through goal setting, mentoring, and training
• Collaborate with Revenue Cycle Management to resolve denied claims related to credentialing/enrollment
• Monitor departmental performance against operating plans and recommend corrective actions

Benefits

• Paid time off, including company holidays, vacation, and sick time
• Medical, dental and vision insurance
• Life insurance and disability protection
• Retirement benefits including an employer match

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Nursing and Residential Care Facilities
• Education Level: Associate degree