Manager of Credentialing - Full Time Days

Cape Fear Valley Health System; United States; On-site; USD 88,000 - 112,000; Full time

Job summary

Cape Fear Valley Health System is seeking a skilled leader to oversee payer enrollment activities across employed and certain contracted providers, hospitals, and group practices. This role will coordinate credentialing, onboarding, and data integrity across CAQH, PECOS, and NC Medicaid systems.

The ideal candidate brings experience with large multi-specialty health systems, strong communication, and a collaborative leadership style to ensure accurate and timely enrollments and revalidations.

Qualifications

• Associate degree or 4 years' experience in practice management considered in lieu of degree.
• Bachelor’s degree preferred for advancement and scope.
• 2 years’ experience in a large multi-specialty health system with credentialing or provider enrollment.
• Strong English communication and interpersonal skills.
• Proficiency with payer enrollment processes and CAQH/PECOS.

Responsibilities

• Collaborate with physician groups and departments on enrollment activities to ensure proper payment.
• Coordinate onboarding of providers for payer enrollment.
• Work with CAQH and other orgs on credentialing applications.
• Maintain consistent NPI, PECOS, NPPES and NC Medicaid data.
• Ensure timely enrollments, reenrollments and revalidations.
• Provide quality control and training for staff.
• Other duties as assigned.

Skills

Payer enrollment

Credentialing coordination

Provider enrollment

Regulatory knowledge

Leadership

Education

Associate’s degree

Bachelor’s degree preferred

Tools

Microsoft Word

Excel

PowerPoint

Access

Job description

Facility Cape Fear Valley Medical Center

Location Fayetteville, North Carolina

Department Physician Financial Services

Job Family Management

Work Shift Days (United States of America)

Summary Oversee, lead and coordinate the payer enrollment activities associated with employed and certain contracted providers, hospitals and group practices within Cape Fear Valley Health System.

Major Job Functions

• Work with Physician groups and Hospital departments on enrollment activities to ensure proper payment
• Works closely with Medical Group and Medical Staff Services to ensure all providers and new groups are onboarded from a payer enrollment perspective
• Work with CAQH and other organizations on the processing of credentialing applications
• Ensures NPI registry, PECOS, NPPES and NC Medicaid systems have consistent information related to CFV entities
• Ensure that enrollments, reenrollments and revalidations are handled timely, accurately and consistently
• Provides quality control measures to ensure that staff are properly trained and executing functions accurately and timely
• Other duties as assigned

Minimum Qualifications

Education and Formal Training:

• Associate’s degree required OR 4 years’ experience as a practice manager or administrator will be considered in lieu of degree
• - Bachelor’s degree preferred

Work Experience:

• 2 years’ experience working with a large multi-specialty health system with knowledge and experience in credentialing and/or provider enrollment required

Knowledge, Skills, and Abilities Required:

• Proficiency in reading, writing, and speaking the English language
• Excellent interpersonal skills with the ability to interact with internal hospital department leadership as well as outside organizations
• Strong written and verbal skills, be results oriented, and exemplify a team player attitude
• Expert skills in Microsoft Word, Excel, PowerPoint and Access
• Ability and willingness to work on a variety of activities and projects
• Ability to work with people in a tactful, diplomatic manner

Physical Requirements:

• Present a professional image
• Visual and auditory acuity Required

Licenses and Certifications

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity

For exceptional healthcare come to Cape Fear Valley Health where caring employees are committed to integrity, patient-centeredness and excellence throughout the entire healthcare process. At Cape Fear Valley Health, our goal is to improve the quality of every life we touch. Our diverse team of doctors, nurses and staff work together to create a better experience for every patient, every time. Cape Fear Valley is a 950-bed, 8-hospital regional health system, the 8th largest in North Carolina, with more than 1 million inpatient and outpatients annually. A private not-for-profit organization with over 7,000 employees and 850 physicians. Our employees and physicians proudly serve a seven-county region of southeastern North Carolina, including Fayetteville, Fort Bragg, Hope Mills, Raeford, Lumberton, Elizabethtown, Clinton, Lillington, Dunn and beyond. Our medical facilities include Cape Fear Valley Medical Center, Highsmith-Rainey Specialty Hospital, Cape Fear Valley Rehabilitation Center, Behavioral Health Care, Bladen County Hospital, Hoke Hospital, Central Harnett Hospital, Betsy Johnson Hospital, as well as more than 60 medical offices and specialty care clinics spread throughout the Cape Fear region.