Manager, Provider Credentialing – Payer Enrollment

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QualDerm Partners

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

⚖️ Legal

🏥 Healthcare

💰 Venture Round on 2016-02

Consulting • Legal • Healthcare

QualDerm Partners is a comprehensive network dedicated to supporting high-quality dermatology practices and skin care experts across the United States. It empowers dermatologists with management support, access to capital, and strategic alliances to ensure long-term growth and operational efficiency. By facilitating partnerships and enhancing practice infrastructure, QualDerm enables dermatologists to concentrate on delivering outstanding patient care, particularly in fields such as skin cancer care, aesthetics, and cosmetic surgery. QualDerm Partners operates with a culture of quality and innovation, supporting over 158 practices and serving more than 120,000 patients monthly. Their commitment to maintaining physician autonomy while providing robust business support sets them apart in the healthcare sector.

📋 Description

• Oversee provider credentialing, re-credentialing, payer enrollment, and privileging processes nationally across the organization • Oversee credentialing and payer enrollment for new providers, group entities, new and de novo locations, and new payer contracts • Ensure CAQH, Verity, and other credentialing/payer databases are accurate and timely • Maintain accurate provider checklists, credentialing trackers, and Fresh Service tickets • Serve as subject matter expert for payer-related matters and credentialing issues • Collaborate with Payer Contracting, Revenue Cycle Management, Human Resources, Integration, Finance, Compliance, and Operations • Manage credentialing and payer enrollment resources, including hiring, training, onboarding, and skill development • Monitor compliance with health plan requirements, policies, procedures, and regulations • Oversee special projects involving delegated and non-delegated health plan requirements • Ensure timely renewal of provider licenses and certifications and maintain confidential information • Manage information flow among payers, contracted MSO, CIN, PHO, IPA, ACO, and other networks • Coordinate and prepare management reports • Lead process and quality improvement efforts related to payer enrollment, data entry, credentialing committees, and enrollment • Design and review credentialing statistics to drive improvement and accountability • Ensure the Credentialing and Enrollment team is fully trained and able to work independently

🎯 Requirements

• Five (5) to seven (7) years’ experience in managed care credentialing and payer enrollment required • National or multi-state credentialing leadership experience preferred • Experience with payer enrollment for Aetna, BCBS, Cigna, Humana, Medicare, Medicaid, and UHC required • Experience enrolling payers under multiple Tax IDs preferred • Demonstrated analysis, problem-solving, and resolution skills • Ability to communicate effectively with practitioners and providers, including sensitive and confidential information • High attention to detail and exceptional organizational skills • Ability to present complex information concisely and clearly for operational leadership input and education • Compliance knowledge relating to NCQA, CMS, and applicable state laws and regulations for credentialing and payer enrollment • Ability to solve problems, explore options, and use available resources to find effective solutions • Ability to prioritize and meet ongoing deadlines • Ability to function independently and manage multiple projects flexibly • Applicants must be currently authorized to work in the United States on a full-time basis

🏖️ Benefits

• Competitive Pay – Attractive compensation to reward your hard work • Comprehensive Health Coverage – Includes Medical, Dental, and Vision plans • Generous 401(k) Plan – Company matches 100% of the first 3%, plus 50% of the next 2%, with immediate vesting • Paid Time Off (PTO) – Accrue PTO from day one, plus 6 paid holidays and 2 floating holidays each year • Company-Paid Life Insurance – Basic life coverage, with the option for additional plans • Short-term and long-term disability coverage • Accident, critical illness, and identity theft protection plans • Employee Assistance Program (EAP) • Exclusive Employee Discounts • Referral Bonus Program