Director-Payor Enrollment and Credentialing Position Available In York, Pennsylvania

General Summary Is responsible for the strategic leadership, operational oversight, and regulatory compliance of the centralized credentialing/enrollment and primary source verification operations across the organization. Ensures the effective and efficient verification of provider credentials in alignment with organizational policies, payer requirements and accreditation standards, such as those from NCQA, URAC and The Joint Commission. Serves as a key liaison among hospitals, ambulatory practices, payer relations and executive leadership.

Duties and Responsibilities Essential Functions:

Leads and develops a high-performing team of credentialing/enrollment professionals, including managers, specialists and coordinators. Collaborates with executive leadership, medical staff services, compliance, legal, payer contracting and HR to ensure cross-functional alignment. Ensures compliance with all applicable state and federal regulations, payer requirements and accrediting bodies. Oversees quality control for credentialing/enrollment file completeness, timeliness and accuracy. Leads credentialing/enrollment audits and oversees corrective action plans, as needed. Develops and monitors key performance indicators (KPI) to track productivity, turnaround times and expirable. Drives process improvement initiatives to reduce turnaround time and enhance stakeholder satisfaction. Partners with health plans, credentialing/enrollment committees and provider groups to support contracting and enrollment efforts. Partners with physician leadership, recruitment, and onboarding teams to ensure a seamless and efficient credentialing/enrollment process. Develops and implements credentialing/enrollment strategies aligned with health system growth, mergers, and clinical integration efforts. Leads optimalization and utilization of credentialing/enrollment software systems to support scalability and accuracy. Recruits, mentors and retains a high-performing credentialing/enrollment team.

Qualifications Minimum Education:

Bachelors Degree in Health Care Administration, Business Management, or related field required.

Work Experience:

5 years Leadership experience in network credentialing or payer enrollment required.

Licenses:

Certified Provider Credentialing Specialist Upon Hire Preferred or Certified Professional Medical Services Management Upon Hire Preferred Knowledge, Skills, and Abilities:

In-depth knowledge of credentialing/enrollment regulations and best practices Exceptional leadership, communication and stakeholder management skills Analytical and data-driven with strong problem-solving capabilities Expertise with credentialing/enrollment software (e.g.; CACTUS, Verity, ECHO, Axuall) Ability to lead change and foster a culture of compliance and continuous improvement Proficiency in credentialing standards for facilities and health plans, medical terminology and/or business management. Ability to effectively utilize Microsoft Office tools (Excel, Word, PowerPoint) and other software tools as required. WellSpan Health’s vision is to reimagine healthcare through the delivery of comprehensive, equitable health and wellness solutions throughout our continuum of care. As an integrated delivery system focused on leading in value-based care, we encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central Pennsylvania and northern Maryland. Our high-performing Medicare Accountable Care Organization (ACO) is the region’s largest and one of the best in the nation. With a team 23,000 strong, WellSpan experts provide a range of services, from wellness and employer services solutions to advanced care for complex medical and behavioral conditions. Our clinically integrated network of 3,000 aligned physicians and advanced practice providers is dedicated to providing the highest quality and safety, inspiring our patients and communities to be their healthiest.