Geisinger
Senior Director Provider Credentialing and Enrollment
Geisinger, Danville, Pennsylvania, us, 17822
Senior Director Provider Credentialing and Enrollment
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Senior Director Provider Credentialing and Enrollment
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Geisinger . Job Summary Responsible for overseeing all aspects of credentialing, re-credentialing, payer enrollment, and facility enrollment activities for the health system. This leader will drive the development and execution of efficient, compliant, and scalable processes that support timely provider onboarding, maintain payer compliance, and enable accelerated revenue capture across the academic medical center and its affiliated entities. This individual will lead a cross-functional team and collaborate closely with Human Resources, Medical Staff Services, Revenue Management, Legal/Compliance, and Clinical Operations to ensure a streamlined provider lifecycle from hire to billing readiness. Job Duties
Lead the design, implementation, and ongoing refinement of a centralized provider and facility credentialing and enrollment model across the enterprise. Serve as the system's subject matter expert on credentialing and payer/facility enrollment NCQA/JCAHO regulations, delegated agreements, and payer requirements. Ensure alignment of credentialing and enrollment workflows with provider onboarding, privileging, HR, and revenue cycle systems. Manage relationships and negotiations with third-party payers for delegated credentialing and facility enrollment. Partner with key stakeholders to set and monitor KPIs and service level expectations for provider readiness and enrollment turnaround times. Establish communication channels and reporting tools to provide visibility into provider enrollment status across the organization. Supervise credentialing and enrollment teams responsible for provider applications, CAQH maintenance, NPPES updates, PECOS submissions, and commercial payer enrollments. Monitor work queues for urgent enrollment items and escalations. Ensure timely and accurate submission of provider data to all applicable payers. Coordinate with billing and denial management teams to resolve enrollment-related rejections or delays. Provide routine status updates to department chairs, finance leaders, and operational managers regarding pending credentialing/enrollment activity. Review and approve reports summarizing time-to-enroll, first billable date, clean submission rates, and enrollment aging. Oversee delegated credentialing audits and compliance with payer expectations. Evaluate process performance and implement continuous improvement initiatives. Lead cross-functional meetings with HR, Medical Staff Office, Revenue Management, and IT to ensure coordination and address systemic issues. Support organizational growth initiatives by forecasting credentialing/enrollment resource needs and readiness timelines. Requirements
Certified Provider Credentialing Specialist (CPCS) – NAMSS preferred. Certified Professional in Medical Services Management (CPMSM) – NAMSS preferred. AAPC or HFMA credential with broader revenue cycle exposure preferred. Bachelor's Degree-Healthcare Related Degree (Required). Minimum of 7 years-Related work experience (Required). Geisinger is an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
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Join to apply for the
Senior Director Provider Credentialing and Enrollment
role at
Geisinger . Job Summary Responsible for overseeing all aspects of credentialing, re-credentialing, payer enrollment, and facility enrollment activities for the health system. This leader will drive the development and execution of efficient, compliant, and scalable processes that support timely provider onboarding, maintain payer compliance, and enable accelerated revenue capture across the academic medical center and its affiliated entities. This individual will lead a cross-functional team and collaborate closely with Human Resources, Medical Staff Services, Revenue Management, Legal/Compliance, and Clinical Operations to ensure a streamlined provider lifecycle from hire to billing readiness. Job Duties
Lead the design, implementation, and ongoing refinement of a centralized provider and facility credentialing and enrollment model across the enterprise. Serve as the system's subject matter expert on credentialing and payer/facility enrollment NCQA/JCAHO regulations, delegated agreements, and payer requirements. Ensure alignment of credentialing and enrollment workflows with provider onboarding, privileging, HR, and revenue cycle systems. Manage relationships and negotiations with third-party payers for delegated credentialing and facility enrollment. Partner with key stakeholders to set and monitor KPIs and service level expectations for provider readiness and enrollment turnaround times. Establish communication channels and reporting tools to provide visibility into provider enrollment status across the organization. Supervise credentialing and enrollment teams responsible for provider applications, CAQH maintenance, NPPES updates, PECOS submissions, and commercial payer enrollments. Monitor work queues for urgent enrollment items and escalations. Ensure timely and accurate submission of provider data to all applicable payers. Coordinate with billing and denial management teams to resolve enrollment-related rejections or delays. Provide routine status updates to department chairs, finance leaders, and operational managers regarding pending credentialing/enrollment activity. Review and approve reports summarizing time-to-enroll, first billable date, clean submission rates, and enrollment aging. Oversee delegated credentialing audits and compliance with payer expectations. Evaluate process performance and implement continuous improvement initiatives. Lead cross-functional meetings with HR, Medical Staff Office, Revenue Management, and IT to ensure coordination and address systemic issues. Support organizational growth initiatives by forecasting credentialing/enrollment resource needs and readiness timelines. Requirements
Certified Provider Credentialing Specialist (CPCS) – NAMSS preferred. Certified Professional in Medical Services Management (CPMSM) – NAMSS preferred. AAPC or HFMA credential with broader revenue cycle exposure preferred. Bachelor's Degree-Healthcare Related Degree (Required). Minimum of 7 years-Related work experience (Required). Geisinger is an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
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