Credentialing and Enrollment Manager

Position Description 

As the Credentialing & Enrollment Manager, your role involves leading the function of Credentialing and Enrollment at Eleanor. In this role, you will lead internal credentialing, and manage organization and completion of licensing and enrollment. It is your responsibility to ensure that internal credentialing and enrollment workflows are in compliance with state, federal, and accreditation bodies’ standards and reflection of EH core values. This role will collaborate and directly report to the Senior Director of Clinical Quality & Care Model and provide assistance to colleagues, departments, and clinics as needed.

It is important that this role is held by an individual who can serve as a subject matter expert in credentialing and enrollment standards and is enthusiastic about organizing and managing the transfer and completion of tasks. 

This role will involve conducting regular qualitative and quantitative reviews of both internal and external workflows and ensuring adherence to our internal policies and procedures. This role is responsible for developing and executing both short-term and long-term projects aimed at enhancing the quality and efficiency of care provided to Eleanor’s community members. 

Primary Responsibilities: 

Specifically you will:

• Serve as a subject matter expert on which Eleanor Health providers hold an individual license in a specific market, are internally credentialed, and are successfully enrolled with all payer partners for their associated markets 
• Manage the sources of truth that hold/organize this information 
• Communicate this information to stakeholders effectively 
• Partner with Sr. Director of CQCM to inform C&E KPIs and strategy 
• Proactively assess and report resource barriers and/or support needed to meet internal and external timelines 
• Analysis of vendors, options, implementation plan, and expectations 
• Serve as a collaborative partner with internal department leaders 
• People Team
• Staff Development (Operations, Learning & Development) 
• Serve as a supervisor and manager to C&E specialists 
• Responsible for maintenance of job descriptions, scorecards, performance reviews, PTO, etc.
• Build and maintain relationship with external partners and payers 
• Manage the completion and expiration of internal credentialing applications  
• Manage Enrollment rosters for delegated payers & review enrollment rosters for non-delegated payers- track expirations 
• Disseminate rosters on a monthly basis and communicate with payer as needed 
• Manage Audits with delegated payer partners.
• Manage and facilitate communication with external Licensing and Enrollment third-party vendor 
• Build relationship with team leads and customer success representative 
• Communicate priorities and expectations 
• Track completion of tasks, compare with estimates/expectations  
• Track barriers and opportunities for performance improvement
• Provide feedback and address barriers 
• Manage and ensure accuracy of project management boards owned by C&E 
• Licensing source of truth 
• Internal Credentialing source of truth 
• Enrollment source of truth 
• Coordinate with the Revenue Cycle Management team to 
• Triage questions related to licensing, credentialing and enrollment of internal teammates 
• Assist in the resolution of denied claims 
• Communicate with payers on questions or barriers in information 
• Payor portal management
• Monitoring the accuracy and efficiency of the internal policies: 
• 1.I.4.a (2) Credentialing Policy & Procedure 
• 1.I.10. Workforce Education, Training and Credentials Process
• Support onboarding of staff 
• Begin internal credentialing process 
• Add provider into enrollment priority
• Add provider into licensing priority if needed 
• Support offboarding of staff 
• Removal from payor registries/rosters
• Marking staff as inactive in sources of truth for licensing, credentialing & enrollment 
• Other responsibilities and tasks as needed and assigned 

Qualifications

• • At least three years of experience in healthcare credentialing and enrollment management.
  • Have experience with cross-market licensing and enrollments.
  • Have expertise in current NCQA standards.
  • You are passionate about working with our payer partners, CVO, and internal stakeholders to improve TAT’s/KPI’s.
  • Have experience serving on interdisciplinary teams and enjoy working in a collaborative environment
  • Enjoy finding opportunities to improve, developing solutions, and communicating those opportunities to peers & leaders in an actionable and collaborative way
  • Enjoy meeting new people and establishing mutually beneficial working relationships

Competencies

• Possess innovative and critical thinking skills
• Effective communication & high responsiveness 
• Clear writer of standardized operational procedures 
• Demonstrate the ability to grasp new concepts rapidly
• Understanding of basic statistics
• Expertise with Collaborative Practice Agreement across multiple markets.
• Flexible and adaptable to rapid change & quick deadlines
• Excellent organizational skills
• Meticulous attention to detail
• Capability to work remotely from either a home office or a clinic office
• Technically savvy and ability to use G-Suite effectively
• Expertise with Monday.com project management board

Compensation & Benefits:

The target annual compensation range for this position is $70,000-95,000. The actual compensation offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job.

Eleanor Health offers a generous benefits package to full-time employees, which includes:

• • Generous PTO policy - unplug, relax, and recharge!
  • 9 observed company holidays + 3 floating holidays- We encourage you to use the additional 3 floating holidays to accommodate personal beliefs/practices
  • Wellness Days - In lieu of “Sick Time” which typically applies only when you are ill, we encourage you to proactively manage your overall wellbeing, both physical and mental, as well as the wellbeing of those who play important roles in your life.
  • Fully covered medical and dental insurance plan, with affordable vision coverage - We are a health first company, and we strive to make our plans affordable and accessible
  • 401(k) plan with 3% company contribution- We are excited to be able to support the long-term financial well-being of our team in a way that reinforces Eleanor’s commitment to equity.
  • Short-term disability - We understand that things happen, we want you to feel comfortable to take time to get better.
  • Long Term Disability - Picks up where Short Term Disability leaves off (employee paid).
  • Life Insurance - Both Eleanor and employee-paid options are available.
  • Family Medical Leave - Eleanor Health’s Paid Family & Medical Leave (“PFML”) is designed to provide flexibility and financial peace of mind for approved family and medical reasons such as the birth, adoption, or fostering of a child, and for serious health conditions that you or a family member/significant other might be facing.
  • Wellness Perks & Benefits- Mental Health is important to us and we want our employees to have the accessibility you deserve to talk things through, zen with a mindfulness app, or seek assistance from health advocates
  • Mindfulness App Reimbursement

About Eleanor Health

Eleanor Health is the first outpatient addiction and mental health provider delivering convenient and comprehensive care through a value-based payment structure. Committed to health and wellbeing without judgment, Eleanor Health is focused on delivering whole-person, comprehensive care to transform the quality, delivery, and accessibility of care for people affected by addiction.

To date, Eleanor Health operates multiple clinics and a fully virtual model statewide across Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, Texas, Florida, and Washington, delivering care through population and value-based partnerships with Medicare, Medicaid, and employers.

If you are passionate about providing high quality, evidence based care for individuals with substance use disorder through an innovative practice and about building a great business that makes a difference, Eleanor Health is an ideal opportunity for you. We seek highly skilled, motivated and compassionate individuals who take responsibility and adapt quickly to change to join our deeply committed and collaborative team.

Job Types: Full-time