Providence Health & Services Senior Manager, Licensing, Credentialing & Payor Enrollment Telehealth PSJH in California
Providence St. Joseph Health is calling a Senior Manager, Licensing, Credentialing & Payor Enrollment Telehealth PSJH to work remotely within our footprint states: AK, CA, MT, OR, TX and/or WA.
We are seeking a Senior Manager, Licensing, Credentialing & Payor Enrollment Telehealth PSJH who will be responsible for the development and operations of the Providence Telehealth Provider Licensing and Credentialing, and Payor Enrollment of multiple telehealth service lines across multiple states for physicians, advanced practice professionals, and social workers. Works closely with Service Line Administrative Leaders, Service Line Medical Directors, and Provider Network leadership.
They will act as a liaison for all telehealth providers managing expectations and reducing paperwork impact. They will manage the relationships with our MSO partners in both internal and external facilities. This includes streamlining workflows and creating consistency in our interactions with those partners. They will create, administer, and maintain tracking systems and analyze data to create reports for leadership visibility, staffing projections, and timelines. They will monitor credentialing progress for all implementations to report out any at risk items. They will consult on minimum qualifications for providers for new service lines to support credentialing efforts in a high volume of facilities. They will focus on both building solid foundations for this work and process improvement to allow for significant scaling.
The incumbent performs all duties in a manner that promotes Providence's mission, values, and philosophy. In all aspects, he/she serves as a role model for the values and mission of the organization.
In this position you will have the following responsibilities:
Manage all licensing activities and workflows for all enterprise telehealth clinicians collaborating with state boards and other partner agencies.
Manage all credentialing activities and workflows for all enterprise telehealth clinicians collaborating with both internal and external Medical Staff Office partners. Manage quality oversight data and reporting as it pertains to OPPE requirements and the facilitation of Credentialing by Proxy.
Manage all payor enrollment activities and workflows for all enterprise telehealth clinicians collaborating with enrollment teams across the system including delegated enrollment partners and other regional partners. Work with the billing manager to maximize reimbursement rates.
Administer licensing and credentialing reports and retrospectives with involved team members for process improvement including clinical workflow alignment and technical and resource requirements. Review of processes to determine opportunities to decrease credentialing timeframes.
Develop and administer a process to track telehealth provider credentialing and licensing timeframes, QI monitoring, licensing and credentialing fees, across multiple service lines, and across multiple regions.
Collaborate with other telehealth analysts and IS, to design, organize, prepare and distribute complex reports utilizing multiple data systems.
Provide comprehensive instruction and guidance regarding PSJH telehealth licensing and credentialing process for practitioners and partner Medical Staff Offices. Participate in organizational initiatives by providing expertise on medical service topics and advising on accreditation and regulatory issues in order to maintain ongoing compliance.
Support the implementation of a quality oversight committee/peer review process for telehealth clinical services. Report adverse actions taken against a practitioner/provider by notifying the appropriate service line leadership and Medical Staff Offices as appropriate.
Support the development of the framework and strategy for the conversion of regional providers to system providers as it relates to their licensing and credentialing.
Plan, coordinate and implement system-wide programs and processes facilitated by the licensing and credentialing team.
Schedule and organize rounding with partner Medical Staff Offices at least annually to continue to build relationships with our partner sites as we continue to grow and add providers.
Collaborate with Sr Manager Provider network and other Telehealth leadership to partner with Medical Staff Offices to accept Credentialing by Proxy.
Implement and manage providers payer credentialing/enrollment for enterprise telehealth providers in collaboration with regional provider enrollment offices from identified states of practice. Work as a liaison between providers and a payer credentialing office to facilitate effective and efficient approval of payer enrollment. Work with billing and coding team to ensure Providers are enrolled correctly and address any denials in a timely manner.
Create, implement and maintain tracking for provider CME for multiple state licensing requirements for all service lines.
Manage the licensing and credentialing team by developing of new positions as needed, interviewing job candidates, selecting and training new employee, ensuring compliance with established department performance expectations and evaluating staff performances.
Perform timely and accurate management of Payroll/Timekeeping functions.
Provide oversight to the licensing and credentialing budgets. Accurate and timely monthly reconciliation of licensing and credentialing budgets.
Perform annual performance evaluations of licensing and credentialing team and provide resources/support for their professional and development growth.
Oversee the development and implementation of department policies and procedures, evaluating process improvement across the team and align workflows across service lines. Ability to create original forms and instructions for new processes as needed.
Required qualifications for this position include:
Bachelor's Degree or equivalent education/experience.
6 years High-level admin/program coordination experience, preferably in a healthcare setting.
4 years of Leadership experience.
4 years Medical Staff Office experience.
Track record of delivering high levels of customer satisfaction.
Demonstrated track record of being a change agent, leaving every team and process better than you found it.
Experience working effectively with senior administrators and professionals, including sensitivity in handling confidential information and urgent matters in a thoroughly professional and timely manner.
Sophisticated project management experience.
Track record of efficient prioritization and organization of multiple requests.
Preferred qualifications for this position include:
- Preferred: CPMSM.
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer a full comprehensive range of benefits — see our website for details —http://www.providenceiscalling.jobs/rewards-benefits
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Non-Clinical Director/Executive
Other Location(s): Montana, California, Washington, Oregon, Texas, Alaska
Req ID: 324370