Payor Contracts, Credentialing Manager

PathGroup•Brentwood, TN

20d

About The Position

The Payor Contracting, Enrollment and Credentialing Manager is responsible for the day-to-day requirements of Payor Credentialing and Enrollments. This role requires a strong self-motivated work ethic, the ability to determine without guidance what needs to be worked on and prioritized, a deep understanding of both laboratory, group and physician payor enrollment, credentialing, re-credentialing, healthcare operations, and the ability to implement processes. The Manager will partner with leadership to focus on optimizing revenue standardizing processes, building and maintaining strong Payor relationships, and ensuring positive internal and external client experiences.

Requirements

High School Diploma or GED is required.
5-7 years of Credentialing Management experience in a managed care or healthcare environment. Laboratory credentialing experience is required.
Exceptional problem-solving skills and the ability to think strategically and execute operational initiatives.
Strong communication, interpersonal, and leadership skills, with the ability to effectively manage cross-functional relationships.
Proven track record in managing provider data management systems, client, and Payor relationships.
In-depth knowledge of credentialing processes, regulatory requirements, and healthcare industry standards.

Nice To Haves

Bachelor's degree is preferred.
Certified Provider Credentialing Specialist (CPCS) preferred.

Responsibilities

Holding a major role of responsibility with a high-performing Payor credentialing team, fostering a culture of accountability, collaboration, and continuous improvement.
Establishes and preserves quality working relationships with internal and external customers, utilizing excellent customer service skills to solidify relationships.
Develop and continuously evaluate and improve Payor enrollment and credentialing processes and systems, leveraging technology, vendors, and best practices to enhance quality and productivity.
Monitor industry trends and regulatory changes to proactively adjust processes and ensure continued compliance.
Comply with all State and Federal Laws regarding an effective Compliance Program, inclusive of HIPAA Privacy and Security.
Adhere to the organization's Code of Conduct and be familiar with all compliance policies and procedures relevant to this position.
Hold oneself accountable for completing all activities in a timely manner.
Partner with leadership to formulate and integrate Payor contracting strategies.
Perform all job responsibilities in alignment with the industry's best security practices and regulatory guidelines to protect the confidentiality, integrity, and availability of protected health information and other sensitive company data.
Must be familiar with and abide by the Corporate Compliance Program and all Corporate policies, including the Privacy and Security policies.
Work with other departments within PathGroup and subsidiaries.
Nothing in the job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.