Credentialing & Enrollment Program Manager

Location: InteCare Administrative Offices, Indianapolis, Indiana

Reports to: Chief Operating Officer

Supervises: Credentialing Account Representatives and Specialists

This is Full-Time, Salaried, Exempt Position


This is a manager level position with direct responsibilities key to the success of the organization that requires working with a team of other managers and leaders across departments.  This position is responsible for the ongoing development and oversight of the Credentialing and Enrollment Program specifically. Responsibilities include: supervision of all Credentialing Account Representatives and Specialists;  oversight of all day to day program operations and responsible to ensure quality services are provided; monitoring and reporting of program performance measures; oversight and final completion and submission of all Client reports and billing; and assist the business development in program growth.  In addition, the Credentialing and Enrollment Program Manager will also be required to manage and be responsible for a portion of current Client accounts.

Scope of Role/Principal Responsibilities
  1. Day-to-day responsibility for the management and advancement of the InteCare Credentialing and Enrollment Program which will include, but is not limited to: continuing to improve and develop internal procedures and policies; implementing standard protocols and required forms/templates; assisting with program marketing and business development onboarding of new groups/agencies; and ongoing supervision of all identified program staff.
  2. Implement productivity standards for the program that align with  the program’s financial goals. Assign these standards to staff, and monitor staff productivity against these standards.
  3. In collaboration with the InteCare leadership and managers, set and attain financial goals that insure the program is viable and realizing ongoing growth in revenues.
  4. Assign InteCare Account Representatives for each new Client account
  5. Initiate, review, and complete monthly Client reporting and all needed program reporting for quality purposes
  6. Monitor and oversee completion of contractual or other required corporate activities
  7. Develop quality initiatives throughout the year and implement quality controls.  Conduct oversight audit activities for program staff to ensure quality of program data, services and identify opportunities for process improvements
  8. Hire, train and supervise additional staff as needed.
  9. Provide education and training to new staff and develop new staff as program growth occurs
  10.  Seek education regarding credentialing and enrollment requirements and/or changes at the federal, state and local levels including but not limited to laws and licensing requirements, CAQH requirements, and payor specific requirements.
  11.  Chair and facilitate all Credentialing & Enrollment program meetings
  12.  Participate as a team player with InteCare’s management structure and participate in Management Committees and all required presentations at Board and/or Community meetings
  13.  Conduct all activities as required by an account representative or specialist.
  14.  Serve as the primary Payor Liaison and contact for all assigned contracted organizations and/or groups, which includes resolving participating practitioner credentialing issues in a timely, professional and organized manner as well as assisting all staff if the issue is escalated.
  15.  Initiate, process, complete and maintain all assigned organization and/or group credentialing activities which includes, but is not limited to, completion and submission of Payor credentialing application packets and ongoing maintenance of all documentation and annual updates. This includes the initial credentialing and recredentialing application packets, address changes, Tax ID changes, name changes, etc. as required.
  16.  Facilitate and assist as requested with organization and/or group Payor contracting processes
  17.  Review, assist, participate and recommend processes to contracted organization and/or group administrators for improvement of credentialing and contracting processes
  18.  Conduct data entry as required for all credentialing updates in national and Payor credentialing information systems
  19.  Ensure that all provider information is accurately downloaded into the program database system
  20.  Update and maintain all required provider information in the program database in order to ensure accuracy and timeliness of Client reporting and Provider Status Summary review
  21.  Ability to monitor and ensure that all team members maintain strict confidentiality of credentialing information.
  22.  All other duties as assigned.

Required Education, Training, and Professional Licenses & Credentials: Bachelor degree required; preference in health care, mental health care, health-care administration related field.

Required or Preferred Prior Work Experience: Experience with both medical and behavioral healthcare credentialing activities and supervision of staff preferred; Require experience with working in a professional team environment conducting credentialing services for no less than three (3) years, as well as experience with public speaking, presentations and written reporting.

Expected Professional Competencies & Skills:
  • Excellent writing and editing skills;
  • Excellent management and support skills
  • Fundamental understanding of both medical and behavioral healthcare;
  • Excellent organization, time and task priority management skills;
  • Knowledge in personal computer applications, spreadsheet applications, Word operations as well as basic understanding of use of the internet, Outlook and Power Point.
  • Excellent verbal and interpersonal skills in dealing with practitioners, administrators, and Payors
  • Thorough knowledge of insurance industry, including expectations of Private and Public Payors in the insurance industry
  • Prior experience working in a professional environment
  • Excellent documentation skills, including writing notes, letters, reports
  • Must be highly organized, efficient, works independently and diligent with follow up
Working Conditions:
  • Because of the critical nature and complexity of this position, the Credentialing and Enrollment Program Manager shall be required to provide the Company 30 days notice of voluntary termination.
  • Primarily in Office Setting
  • Travel as Required; Minimal

Interested candidates can send resumes to Lara Williams