Jobs in Cambridge, United States

Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

Yes

Job Summary:

Responsible for overseeing all aspects of credentialing, re-credentialing, payer enrollment, and facility enrollment activities for the health system. This leader will drive the development and execution of efficient, compliant, and scalable processes that support timely provider onboarding, maintain payer compliance, and enable accelerated revenue capture across the academic medical center and its affiliated entities. This individual will lead a cross-functional team and collaborate closely with Human Resources, Medical Staff Services, Revenue Management, Legal/Compliance, and Clinical Operations to ensure a streamlined provider lifecycle from hire to billing readiness.

Job Duties:

• Lead the design, implementation, and ongoing refinement of a centralized provider and facility credentialing and enrollment model across the enterprise.
• Serve as the system's subject matter expert on credentialing and payer/facility enrollment NCQA/JCAHO regulations, delegated agreements, and payer requirements.
• Ensure alignment of credentialing and enrollment workflows with provider onboarding, privileging, HR, and revenue cycle systems (e.g., Epic, Workday, Symplr, VerityStream CredentialStream, MD-Staff, CAQH, PECOS, NPPES).
• Manage relationships and negotiations with third-party payers for delegated credentialing and facility enrollment.
• Partner with key stakeholders to set and monitor KPIs and service level expectations for provider readiness and enrollment turnaround times.
• Establish communication channels and reporting tools to provide visibility into provider enrollment status across the organization.
• Supervise credentialing and enrollment teams responsible for provider applications, CAQH maintenance, NPPES updates, PECOS submissions, and commercial payer enrollments.
• Monitor work queues (manual or electronic) for urgent enrollment items and escalations.
• Ensure timely and accurate submission of provider data to all applicable payers, including Medicare, Medicaid, and commercial plans.
• Coordinate with billing and denial management teams to resolve enrollment-related rejections or delays.
• Provide routine status updates to department chairs, finance leaders, and operational managers regarding pending credentialing/enrollment activity.
• Review and approve reports summarizing time-to-enroll, first billable date, clean submission rates, and enrollment aging.
• Oversee delegated credentialing audits and compliance with payer expectations.
• Evaluate process performance and implement continuous improvement initiatives to reduce delays or administrative burden.
• Lead cross-functional meetings with HR, Medical Staff Office, Revenue Management, and IT to ensure coordination and address systemic issues.
• Support organizational growth initiatives (e.g., new programs, acquisitions, provider group expansions) by forecasting credentialing/enrollment resource needs and readiness timelines.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

#LI-REMOTE

Position Details:

Certified Provider Credentialing Specialist (CPCS) – NAMSS preferred. Certified Professional in Medical Services Management (CPMSM) – NAMSS preferred. AAPC or HFMA credential with broader revenue cycle exposure preferred.

Education:

Bachelor's Degree-Healthcare Related Degree (Required)

Experience:

Minimum of 7 years-Related work experience (Required)

Certification(s) and License(s):

Skills:

Office Administration

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.

• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
• INNOVATION : We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.