The best thing about this role Are you looking to make a difference by improving the health of our patients? Here you will find an innovative culture that is patient-focused and dedicated to making a difference. We are committed to helping the population we serve, and our communities, achieve optimum health and enjoy the best quality of life possible. What you'll do The Manager of Delegated Credentialing and Enrollment oversees all aspects of provider credentialing, recredentialing, and enrollment processes, ensuring compliance with regulatory and accreditation standards. This role manages staff and vendor relationships, maintains systems and databases, and supports cross-functional coordination to optimize provider onboarding and reimbursement workflows. This role ensures timely and accurate submission of applications, manages staff performance, and collaborates with internal departments to support clean claims and regulatory compliance. + Decision Maker + Credentialing & Enrollment Operations + Oversee delegated and non-delegated credentialing and enrollment processes and staff + Manage oversight of provider rosters and ensure timely updates to payers and internal systems + Monitor and track provider’s expirable documents and ensure timely renewals + Coordinate onboarding and offboarding of provider processes related to credentialing and enrollment + Develop and implement provider orientation and annual reviews regarding credentialing requirement + Compliance & Quality Assurance + Ensure compliance with NCQA, TJC, CMS, CAQH, NPPES, and payer-specific standards + Conduct internal and external audits in accordance with delegated agreements + Maintain and update credentialing policies and procedures + Perform quality assurance reviews and support the Quality Improvement Plan + Systems & Data Management + Manage credentialing databases (e.g., Verity Stream/Credential Stream) and electronic application systems + Recommend and implement technological solutions to improve departmental efficiency + Recommends systems for the department utilizing the most current software in order to maximize efficiencies + Oversee the submission of provider data to IT for system updates and reimbursement processing for accuracy + Lead coordination with Information Technology to maintain synchronization across provider databases and interfaced applications + Oversee EPIC provider setup processes and ensure timely ticket submissions for system updates + Ensure provider coverage arrangements, terminations, and staff listings are communicated to payers and internal departments + Communication & Stakeholder Engagement + Ensure timely communication of provider status changes to internal departments and payers + Represent the organization professionally in internal and external forums + Disseminate important updates and receive feedback from divisional and departmental staff + Address issues and concerns promptly and effectively + Skilled Communicator + Disseminates timely and effective communication with departmental and divisional staff to keep them aware of important corporate, divisional and departmental information and to receive information and highlights from them + Follows up on all issues and concerns in an effective and timely manner + Staff Leadership & Development + Supervise Credentialing and Enrollment Specialists/Coordinators and/or vendor staff + Conduct performance appraisals and develop standards of performance + Support staff development through goal setting, mentoring, and training + Maintain job descriptions and performance evaluation tools + Monitors and makes recommendations on departmental structure, operating procedures and staffing to meet the financial needs of the organization and the network + Develops, implements and follows written procedures and policies to ensure Regulatory and accreditation standards are met + Team Builder + Supports the development of staff by developing goals and cultivating individual talents and monitors divisional staff’s current and future educational needs + Develops and maintains job descriptions and performance appraisal forms for each position within the department + Revenue Cycle Coordination + Collaborate with Revenue Cycle Management to resolve denied claims related to credentialing/enrollment + Monitor EPIC work queues to ensure timely and accurate follow-up + Provide accurate data on attending and referring providers for financial reporting + Works effectively with other divisions, affiliates and various outside agencies to ensure operational and organizational issues are being addressed + Agent for Change + Communication & Stakeholder Engagement + Ensure timely communication of provider status changes to internal departments and payers + Represent the organization professionally in internal and external forums + Disseminate important updates and receive feedback from divisional and departmental staff + Address issues and concerns promptly and effectively + Is self-reliant, accomplishing goals through independent investigation, self-motivation and analytical problem-solving skills + Develop and implement new provider orientation and annual review for all providers + Monitors performance against annual departmental operating plans and recommends corrective actions where appropriate + Strategic & Financial Oversight + Monitor departmental performance against operating plans and recommend corrective actions + Ensure expenditure remains within budget + Recommend programs and services to enhance internal and external customer satisfaction + Conducts self in a manner that is consistent with organizational values and as an example to others + Ensures the consistent application of policy throughout the organization + Represents the organization to both internal and external constituent groups in such a manner as to enhance the image of the corporation and to further its objectives + Performs similar or related duties as requested or directed What we need from you Education: + 2 Year/Associate Degree, required + (concentration in healthcare Degree reimbursement and/or healthcare administration) with an additional 2 years' experience as listed below may be considered + Experience may be considered in lieu of education Experience: + Minimum 5 years of experience in healthcare credentialing and enrollment for physician group practice and facilities, required Licensure/Certifications: + Credentialing Specialist (CPCS) or ability to attain eligibility, preferred Skills: + Organizing/Categorizing Records + Interacting with People + Communication + Accounting + Computer Skills Physical Requirements: + Sedentary Work - Exerting up to 10 lbs of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking or standing are required only occasionally, and all other sedentary criteria are met + Occasional balancing, climbing, crouching, grasping, kneeling, lifting, pulling, pushing, reaching, repetitive motion, standing, stooping, visual acuity (color, depth, perception), walking + Frequent hearing + Constant typing/clerical/dexterity, seeing/monitor/computer use Travel: + Occasional Travel - The job may require travel from time- to-time, but not on a regular basis Total Rewards Bassett Healthcare Network’s commitment to our employees includes benefit programs carefully designed with the needs and values of all our employees in mind. Many of the benefits we offer are paid fully or in large part by Bassett. Our generous benefits offerings include: + Paid time off, including company holidays, vacation, and sick time + Medical, dental and vision insurance + Life insurance and disability protection + Retirement benefits including an employer match + And more! Specific benefit offerings may vary by location and/or position. Pay Range Salary is based on a variety of factors, including, but not limited to, qualifications, experience, education, licenses, specialty, training, and fair market evaluation based on industry standards. The above compensation range represents a good faith belief of the compensation range by Bassett Healthcare Network, and its entities and affiliates, at the time of this posting or advertisement. Pay Range Minimum: USD $74,953.23/Yr. Pay Range Maximum: USD $112,429.85/Yr. We love the difference people bring We provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex (including pregnancy, childbirth, or related condition), age, national origin or ancestry, citizenship, disability, marital status, sexual orientation, gender identity or expression (including transgender status), genetic predisposition or carrier status, military or veteran status, familial status, status as a victim of domestic violence, or any other status protected by law.