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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.

Education Qualifications:

Key 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 strategic planning and operational efforts

+ Manage and monitor delegated credentialing agreements to ensure compliance 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 Requirements:

+ 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

Employee Benefits at Essentia Health: At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.

**Job Location:** 520 Building - Duluth

**Shift Rotation:** Day Rotation (United States of America)

**Shift Start/End:** days/days

**Hours Per Pay Period:** 80

**Compensation Range:** $76315 - $114483 / year

Union:

**FTE:** 1

Weekends:

Call Obligations:

Sign On Bonus:

It is our policy to afford EEO to all individuals, regardless of race, religion, color, sex, pregnancy, gender identity, national origin, age, disability, family medical history, genetic information, sexual orientation, marital status, military service or veteran status, culture, socio-economic status, status with regard to public assistance, and other factors not related to qualifications, including employees or applicants who inquire about, discuss, or disclose their compensation or the compensation of other employees or applicants, or membership or activity in a local human rights commission, or any other category as defined by law.