Senior Manager, Credentialing & Enrollment

Summary

Join Imagine Pediatrics as a Senior Manager, Credentialing & Enrollment and oversee the operations of the Credentialing department. Manage staff processing provider licensure, Medicaid enrollment, and health plan credentialing. Supervise credentialing staff in managing applications, verifications, and credentialing file preparation. Manage the Credentialing Program, ensuring compliance and administration of the Delegated Credentialing Program. Execute policies and procedures to ensure accurate application submission. Facilitate the Credentialing Committee and present files for review. Act as a liaison with licensure boards, Medicaid agencies, and health plan teams. Analyze and prepare reports on application status and trends. Ensure department milestones and deadlines are met. Develop and design department policies, workflows, and training documentation. Manage the configuration and maintenance of the Credentialing platform. This role requires a passion for reimagining pediatric healthcare.

Requirements

• Have good working knowledge of guidelines and requirements of Licensure and Medicaid across several markets
• Excellent communication skills with internal stakeholders at variable levels (including Executive Leadership)
• Detail oriented with strong organizational skills

Responsibilities

• Manage staff that process Provider Licensure, Medicaid Enrollment, and Health Plan Credentialing requirements for multi-specialty providers
• Supervise Credentialing staff in the day-to-day management of Provider Licensure and Enrollment applications, Primary Source Verifications, Provider Expirables, and Credentialing File preparation
• Manage Credentialing Program, ensuring compliance with regulatory agencies and administration of Delegated Credentialing Program (including Credentialing Committee)
• Execute Credentialing Program policies and procedures to ensure that applications are properly verified and submitted with accuracy by paper or electronic portal
• Ensure Credentialing Files are generated by Specialists in a timely and accurate manner
• Facilitate Credentialing Committee and present Credentialing Files to the Committee for review/approval
• Act as a liaison to the state Licensure boards, Medicaid Agencies, and Health Plan Credentialing Teams regarding the status of applications and correction of any deficiencies identified
• Analyze and prepares reports on status and trends in submitted applications
• Ensure department milestones, deadlines, and SLAs are met
• Develop and designs department policies and procedures, cross-functional workflows, and training documentation for Team/Providers
• Manage configuration and maintenance of Credentialing platform including but not limited to Provider Data accuracy, Credentialing Committee administration, Custom Reporting, Task Management, and Specialist Operational Oversight

Preferred Qualifications

• At least seven years' experience preferred in a capacity as a Credentialing Specialist
• At least five years’ experience preferred as a people manager of at least three team members
• Previous experience managing Credentialing functions in Verifiable and Athena
• CPCS or CPMSM certification highly preferred or working towards certification(s)

Benefits

• Competitive medical, dental, and vision insurance
• Healthcare and Dependent Care FSA; Company-funded HSA
• 401(k) with 4% match, vested 100% from day one
• Employer-paid short and long-term disability
• Life insurance at 1x annual salary
• 20 days PTO + 10 Company Holidays & 2 Floating Holidays
• Paid new parent leave
• Additional benefits to be detailed in offer
• The role offers a base salary range of $110,000 - $130,000 in addition to annual bonus incentive, competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable)