Essentia Health
Central Verification Organization and Enrollment Manager
Essentia Health, Duluth, Minnesota, United States, 55806
Job Description
This leader is responsible for the oversight of the Central Verification Organization (CVO) and enrollment team, working under limited supervision and reporting to the leader of Medical Staff Services. This position manages all aspects of provider and facility enrollment with commercial payors, Medicare, and Medicaid, and ensures ongoing compliance with federal, state, and accreditation requirements. The Manager also oversees the medical staff credentialing process – including initial and recredentialing, expirables management, delegated credentialing agreements, and primary source verification. This role requires a results-driven leader who can guide day-to-day operations, ensure data integrity, improve process efficiency, and lead a high-performing team.
Responsibilities
Lead and manage the overall operations of the CVO and provider enrollment
Develop, implement, and enforce standard work and internal controls to ensure compliance, process efficiency, and quality outcomes
Oversee day-to-day activities, including application processing, primary source verification, and recredentialing
Monitor key performance indicators and analyze credentialing/enrollment reports to identify trends and opportunities for process improvement
Ensure compliance with accrediting bodies and regulatory agencies (e.g., NCQA, CMS, The Joint Commission)
Ensure the accuracy and integrity of credentialing data in the credentialing database; collaborate with system analysts and department leadership to support system optimization
Serve as the CVO and enrollment subject matter expert and liaison for organizational senior level leadership (e.g. revenue cycle, clinical operations) in support of strategic planning and operational efforts
Manage and monitor delegated credentialing agreements to ensure compliance and operational excellence
Lead departmental meetings and drive effective communication across teams
Hire, train, supervise, and evaluate credentialing and enrollment staff; provide coaching, performance feedback, and professional development
Education Qualifications
Bachelors degree in healthcare administration or related field, or Certified as a Credentialing Specialist (CPCS) or Certified Provider Enrollment Specialist certified
Required Qualifications
Minimum of 3 years’ experience in Credentialing and/or Provider Enrollment
Proven ability to lead and develop teams in a high-volume, compliance driven environment
Preferred Qualifications
Working knowledge of medical staff/provider credentialing concepts and comprehensive knowledge of state, and federal regulatory requirements and accreditation standards preferred
Certified Professional Credentialing Specialist - CPCS
Certified Provider Enrollment Specialist - CPES
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This leader is responsible for the oversight of the Central Verification Organization (CVO) and enrollment team, working under limited supervision and reporting to the leader of Medical Staff Services. This position manages all aspects of provider and facility enrollment with commercial payors, Medicare, and Medicaid, and ensures ongoing compliance with federal, state, and accreditation requirements. The Manager also oversees the medical staff credentialing process – including initial and recredentialing, expirables management, delegated credentialing agreements, and primary source verification. This role requires a results-driven leader who can guide day-to-day operations, ensure data integrity, improve process efficiency, and lead a high-performing team.
Responsibilities
Lead and manage the overall operations of the CVO and provider enrollment
Develop, implement, and enforce standard work and internal controls to ensure compliance, process efficiency, and quality outcomes
Oversee day-to-day activities, including application processing, primary source verification, and recredentialing
Monitor key performance indicators and analyze credentialing/enrollment reports to identify trends and opportunities for process improvement
Ensure compliance with accrediting bodies and regulatory agencies (e.g., NCQA, CMS, The Joint Commission)
Ensure the accuracy and integrity of credentialing data in the credentialing database; collaborate with system analysts and department leadership to support system optimization
Serve as the CVO and enrollment subject matter expert and liaison for organizational senior level leadership (e.g. revenue cycle, clinical operations) in support of strategic planning and operational efforts
Manage and monitor delegated credentialing agreements to ensure compliance and operational excellence
Lead departmental meetings and drive effective communication across teams
Hire, train, supervise, and evaluate credentialing and enrollment staff; provide coaching, performance feedback, and professional development
Education Qualifications
Bachelors degree in healthcare administration or related field, or Certified as a Credentialing Specialist (CPCS) or Certified Provider Enrollment Specialist certified
Required Qualifications
Minimum of 3 years’ experience in Credentialing and/or Provider Enrollment
Proven ability to lead and develop teams in a high-volume, compliance driven environment
Preferred Qualifications
Working knowledge of medical staff/provider credentialing concepts and comprehensive knowledge of state, and federal regulatory requirements and accreditation standards preferred
Certified Professional Credentialing Specialist - CPCS
Certified Provider Enrollment Specialist - CPES
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