Senior Director, Managed Care Credentialing And Payor Enrollment Operations

• Department: Executive Office Nursing and Operations Infrastructure
• Schedule: Full-Time, 8-hour day shift, Monday-Friday, Partially Remote with 30% travel.
• Facility: Ascension

• Standardize provider enrollment processes. Ensure provider rosters are submitted to payors according to payor requirements. Track process efficiency and engage in continuous process improvement. Ensures resources are established and maintained to make providers’ plan participation statuses available to the business and appropriate functional teams.
• Standardize, direct and track efficiency of payor Credentialing and re-credentialing processes and policies to comply with delegated payor contracts. Ensure processes and policies will satisfy payor audits.
• Participate as subject matter experts for interactions among, but not limited to, Health Plans, PHOs, ACOs, revenue cycle, Managed Care contracting, and providers pertaining to rostering credentialed and re-credentialing providers. Partner with key stakeholders to resolve issues such as claim holds or disputes.
• Establish and lead strategies to collect payor required information. Directs initiatives to modify data collection in accordance with payor changes.
• Develop policies and procedures to comply with accreditation organization’s best practices and auditors. Ensures appropriate training and compliance is administered regarding all federal/state laws and healthcare accreditation/regulatory agencies.
• Foster a culture of continuous improvement by regularly reviewing and evaluating processes. Identify areas for further alignment, process improvement, and address any gaps or deficiencies that arise. Encourage feedback from stakeholders and incorporate their insights into ongoing improvement efforts.

• Provides expertise in the areas of Managed Care Credentialing, and (delegated and non-delegated) provider enrollment in alignment with URAC, NCQA and Joint Commission standards.
• Skilled leading major process designs and re-designs to achieve turnaround time goals.
• Sets strategy, goals and KPIs for the department.
• Responsible for hiring, staffing, evaluating and performance management of the department.
• Demonstrated ability to coach and mentor individuals. Effective at leading remote teams.
• Can demonstrate audit experience.
• Can demonstrate ability to work in a large organization.
• Can demonstrate understanding of how credentialing impacts payor arrangements and achievement of quality indicators.

• Personal relationships with payors.

• High School diploma equivalency with 5 years of applicable cumulative job specific experience required, with 2 of those years being in leadership/management OR Associate's degree/Bachelor's degree with 3 years of applicable cumulative job specific experience required, with 2 of those years being in leadership/management.

Additional Preferences:

• 7 years of work experience, preferred.
• 5 years of leadership or management experience, preferred.
• 10 years of Managed CareCredentialing and Payor Enrollment Operations experience, preferred.
• Process engineers or Six Sigma, Lean training, preferred.
• Experience or certification in Six Sigma, PMP, or TQM experience, preferred.
• Bachelor’s degree or Master’s degree, preferred.
• Must be creative, agile, innovative, strategic, ability to organize and delegate, problem-solver, team player, flexible, have a understanding of technical demands and have a growth mindset.

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  Please note, benefits and benefits eligibility can vary by position, exclusions may apply for some roles (for example: Travel, PRN, Short-Term Option, etc.). Actual compensation offer will vary based upon role, education, experience, location, and qualifications. Connect with your Talent Advisor for additional specifics.