Manager, Provider Credentialing

GeneDx

82d • $120,000 - $140,000

About The Position

The Manager of Payer Enrollment and Credentialing at GeneDx plays a pivotal role in ensuring the company receives appropriate reimbursement for services by managing timely and precise payer enrollment, reenrollment, and credentialing processes. This position is vital for maintaining compliance with regulatory standards and establishing relationships with commercial and government payers.

Requirements

• 5-7 years’ experience in healthcare roles with emphasis in credentialing and enrollments, payer policy, or contracting with payer organizations.
• Minimum of 1 year in a leadership or supervisory position.
• Able to handle multiple priorities and consistently meet deadlines.
• Ability to identify issues or gaps in processes, problem-solve, gather feedback and implement solutions.
• Strong technical skills – Microsoft Excel, Word, etc.
• Ability to handle sensitive and confidential information appropriately.
• A college or university degree is preferred. However, relevant experience can be accepted instead of a degree.
• CPCS certification or candidate for certification is preferred.

Responsibilities

• Manages the credentialing of in-network and out-of-network commercial and government payers, achieves and maintains PECOS certification, handles enrollment processes in line with state and federal regulations, and proactively addresses and resolves issues, proposing actionable solutions.
• Handles requests for payer roster assessments, ensuring accurate and up-to-date listings within payer networks.
• Collaborates with the Finance Department to establish single case agreements.
• Negotiate vendor agreements for non-payers, such as State Departments.
• Manage the setup and maintenance of EDI/EFT accounts to ensure payment accuracy.
• Oversees payer portal updates and access for both internal and external stakeholders.
• Collaborates with the Market Access team to ensure provider enrollment and credentialing processes are aligned with payer requirements and contracts.
• Oversees all aspects of payer communication, updates, and management, excluding contract negotiations.
• Prepares and delivers internal educational materials to inform internal stakeholders about credentialing activities and complexities.
• Assumes additional responsibilities as needed within the department beyond the primary duties listed.

Benefits

• Paid Time Off (PTO)
• Health, Dental, Vision and Life insurance
• 401k Retirement Savings Plan
• Employee Discounts
• Voluntary benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Bachelor's degree
• Number of Employees: 501-1,000 employees