Credentialing and Enrollment Manager

Summary

Join Eleanor Health as their Credentialing & Enrollment Manager and lead the credentialing and enrollment function. You will manage licensing, ensure compliance with standards, and serve as a subject matter expert. Responsibilities include managing sources of truth for credentialing information, communicating with stakeholders, and collaborating with internal and external partners. You will also supervise C&E specialists and manage projects to enhance care quality and efficiency. This role requires at least three years of experience in healthcare credentialing and enrollment management, expertise in NCQA standards, and strong communication and organizational skills. Eleanor Health offers a competitive salary and a generous benefits package, including PTO, holidays, wellness days, comprehensive insurance, 401(k), and various other benefits.

Requirements

• At least three years of experience in healthcare credentialing and enrollment management
• Have experience with cross-market licensing and enrollments
• Have expertise in current NCQA standards
• Capability to work remotely from either a home office or a clinic office

Responsibilities

• Serve as a subject matter expert on which Eleanor Health providers hold an individual license in a specific market, are internally credentialed, and are successfully enrolled with all payer partners for their associated markets
• Manage the sources of truth that hold/organize this information
• Communicate this information to stakeholders effectively
• Partner with Sr. Director of CQCM to inform C&E KPIs and strategy
• Proactively assess and report resource barriers and/or support needed to meet internal and external timelines
• Analysis of vendors, options, implementation plan, and expectations
• Serve as a collaborative partner with internal department leaders
• Serve as a supervisor and manager to C&E specialists
• Responsible for maintenance of job descriptions, scorecards, performance reviews, PTO, etc
• Build and maintain relationship with external partners and payers
• Manage the completion and expiration of internal credentialing applications
• Manage Enrollment rosters for delegated payers & review enrollment rosters for non-delegated payers- track expirations
• Disseminate rosters on a monthly basis and communicate with payer as needed
• Manage Audits with delegated payer partners
• Manage and facilitate communication with external Licensing and Enrollment third-party vendor
• Build relationship with team leads and customer success representative
• Communicate priorities and expectations
• Track completion of tasks, compare with estimates/expectations
• Track barriers and opportunities for performance improvement
• Provide feedback and address barriers
• Manage and ensure accuracy of project management boards owned by C&E
• Coordinate with the Revenue Cycle Management team to
• Triage questions related to licensing, credentialing and enrollment of internal teammates
• Assist in the resolution of denied claims
• Communicate with payers on questions or barriers in information
• Payor portal management
• Monitoring the accuracy and efficiency of the internal policies
• Support onboarding of staff
• Begin internal credentialing process
• Add provider into enrollment priority
• Add provider into licensing priority if needed
• Support offboarding of staff
• Removal from payor registries/rosters
• Marking staff as inactive in sources of truth for licensing, credentialing & enrollment
• Other responsibilities and tasks as needed and assigned

Preferred Qualifications

• You are passionate about working with our payer partners, CVO, and internal stakeholders to improve TAT’s/KPI’s
• Have experience serving on interdisciplinary teams and enjoy working in a collaborative environment
• Enjoy finding opportunities to improve, developing solutions, and communicating those opportunities to peers & leaders in an actionable and collaborative way
• Enjoy meeting new people and establishing mutually beneficial working relationships
• Possess innovative and critical thinking skills
• Effective communication & high responsiveness
• Clear writer of standardized operational procedures
• Demonstrate the ability to grasp new concepts rapidly
• Understanding of basic statistics
• Expertise with Collaborative Practice Agreement across multiple markets
• Flexible and adaptable to rapid change & quick deadlines
• Excellent organizational skills
• Meticulous attention to detail
• Technically savvy and ability to use G-Suite effectively
• Expertise with Monday.com project management board

Benefits

• Generous PTO policy - unplug, relax, and recharge!
• 9 observed company holidays + 3 floating holidays- We encourage you to use the additional 3 floating holidays to accommodate personal beliefs/practices
• Wellness Days - In lieu of “Sick Time” which typically applies only when you are ill, we encourage you to proactively manage your overall wellbeing, both physical and mental, as well as the wellbeing of those who play important roles in your life
• Fully covered medical and dental insurance plan, with affordable vision coverage - We are a health first company, and we strive to make our plans affordable and accessible
• 401(k) plan with 3% company contribution- We are excited to be able to support the long-term financial well-being of our team in a way that reinforces Eleanor’s commitment to equity
• Short-term disability - We understand that things happen, we want you to feel comfortable to take time to get better
• Long Term Disability - Picks up where Short Term Disability leaves off (employee paid)
• Life Insurance - Both Eleanor and employee-paid options are available
• Family Medical Leave - Eleanor Health’s Paid Family & Medical Leave (“PFML”) is designed to provide flexibility and financial peace of mind for approved family and medical reasons such as the birth, adoption, or fostering of a child, and for serious health conditions that you or a family member/significant other might be facing
• Wellness Perks & Benefits- Mental Health is important to us and we want our employees to have the accessibility you deserve to talk things through, zen with a mindfulness app, or seek assistance from health advocates
• Mindfulness App Reimbursement