Director, Provider Enrollment
This position interfaces and partners with the Quality Management Leadership team and cross functional business partners to provide expertise in the area of credentialing/re-credentialing of practitioners in alignment with NCQA standards. The position acts as a liaison between SHCN and our Providers and manages the Credentialing and Provider Enrollment team.
- Oversee all aspects of the credentialing/re-credentialing of practitioners in alignment with NCQA standards. Assure compliance with CMS, AHCCCS and other regulatory entities. Also responsible for pre-delegated and annual audits of all credentialing delegated entities. Manage all activities and ensure quality related to credentialing operations and payer enrollment, and provide oversight to ensure the continued growth and development of the organization.
- Responsible for annual quality improvement reports. Prepare credentials files for presentation to committees, payers, and clients within established deadlines or appoint designee. Support Credentialing and Quality meetings on an ongoing basis; coordinating meeting times, schedules, developing agenda and presenting necessary documents for review with the respective committees.
- Train and mentor members of the team. Act as a liaison between SHCN and our Providers. Additionally, educate and effectively work with the credentialing team and clinicians to facilitate a seamless credentialing experience.
- Ensure compliance with regulations and contractual obligations. Effectively use financial information for strategic and operational decision making, participate in the preparation of annual budgets, and monitor performance to budget and meet agreed upon metrics
- Leads the charge in focus and implementation of the organization's culture and strategic plan in a way that aligns to the mission, vision and values of the organization.
Years of Experience: