Manager Provider Credentialing & Enrollment

The Manager of Provider Credentialing & Enrollment is responsible for the operational leadership, oversight, and optimization of Deaconess Health System's provider credentialing verification, provider enrollment, and facility enrollment functions. This position leads teams responsible for primary source verification, provider data integrity, payer enrollment, revalidation, and ongoing monitoring activities that support provider readiness, regulatory compliance, and reimbursement.

The Manager ensures providers and facilities are credentialed, enrolled, and maintained in accordance with applicable regulatory, accreditation, and payer requirements. The position works closely with Medical Staff Services, Revenue Cycle, Managed Care, Physician Recruitment, Practice Operations, Compliance, and Health System leadership to support seamless provider onboarding and uninterrupted reimbursement.

Provider Credentialing Operations

• Lead provider credentialing activities for physicians, APPs, and other practitioners.
• Ensure timely and accurate primary source verification.
• Oversee licensure, board certification, sanctions, exclusions, malpractice, and ongoing monitoring.
• Maintain audit-ready credentialing records.
• Monitor KPI reporting for turnaround times and quality metrics.

Provider and Facility Enrollment

• Lead Medicare, Medicaid, managed care, and governmental payer enrollment activities.
• Oversee initial enrollments, revalidations, provider updates, ownership changes, and terminations.
• Ensure providers and facilities are enrolled timely to prevent reimbursement delays.
• Monitor payer enrollment performance and aging metrics.

Provider Data Management and Integrity

• Maintain provider demographic, credentialing, and enrollment data across enterprise systems.
• Support provider data governance initiatives.
• Collaborate with Revenue Cycle, HR, Information Systems, and Medical Staff Services.

Compliance, Governance, and Audit Support

• Ensure compliance with CMS, ACHC, NCQA, state regulations, and payer requirements.
• Support internal and external audits and accreditation reviews.
• Oversee exclusion screening and sanction monitoring processes.
• Create, update and enforce credentialing enrollment policies.

Leadership and Team Development

• Lead and develop credentialing and enrollment staff.
• Establish and maintain productivity, quality, and service expectations.
• Drive process improvement, automation, and standardization initiatives.

Qualifications

• Bachelor's degree required; Master's degree preferred.
• Five years of credentialing, enrollment, medical staff services, provider operations, or revenue cycle experience.
• Three years of leadership experience preferred.
• CPCS, CPMSM, or CPES certification preferred; if not currently certified, must obtain one of these credentials within three years of hire.