Senior Manager, Credentialing & Enrollment

Job description

Who We Are

Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver ²⁴⁄₇ virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity.

What You’ll Do

The Senior Manager, Credentialing & Enrollment oversees the operations of the Imagine Pediatrics Credentialing department to develop and manage Provider Licensure, Medicaid Enrollment, Health Plan Credentialing and Re-Credentialing with payer partners for a multi-specialty telehealth group across 5+ markets.  You will:

• Manage staff that process Provider Licensure, Medicaid Enrollment, and Health Plan Credentialing requirements for multi-specialty providers.
• Supervise Credentialing staff in the day-to-day management of Provider Licensure and Enrollment applications, Primary Source Verifications, Provider Expirables, and Credentialing File preparation.
• Manage Credentialing Program, ensuring compliance with regulatory agencies and administration of Delegated Credentialing Program (including Credentialing Committee).
• Execute Credentialing Program policies and procedures to ensure that applications are properly verified and submitted with accuracy by paper or electronic portal.
• Ensure Credentialing Files are generated by Specialists in a timely and accurate manner.
• Facilitate Credentialing Committee and present Credentialing Files to the Committee for review/approval.
• Act as a liaison to the state Licensure boards, Medicaid Agencies, and Health Plan Credentialing Teams regarding the status of applications and correction of any deficiencies identified.
• Analyze and prepares reports on status and trends in submitted applications.
• Ensure department milestones, deadlines, and SLAs are met.
• Develop and designs department policies and procedures, cross-functional workflows, and training documentation for Team/Providers.
• Manage configuration and maintenance of Credentialing platform including but not limited to Provider Data accuracy, Credentialing Committee administration, Custom Reporting, Task Management, and Specialist Operational Oversight.

What You Bring & How You Qualify

First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with special health care needs gets the care and support they deserve. You will need:

• At least seven years’ experience preferred in a capacity as a Credentialing Specialist
• At least five years’ experience preferred as a people manager of at least three team members
• Previous experience managing Credentialing functions in Verifiable and Athena
• CPCS or CPMSM certification highly preferred or working towards certification(s)
• Have good working knowledge of guidelines and requirements of Licensure and Medicaid across several markets
• Excellent communication skills with internal stakeholders at variable levels (including Executive Leadership)
• Detail oriented with strong organizational skills

What We Offer (Benefits + Perks)

The role offers a base salary range of $110,000 - $130,000 in addition to annual bonus incentive, competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary.

We provide these additional benefits and perks:

• Competitive medical, dental, and vision insurance
• Healthcare and Dependent Care FSA; Company-funded HSA
• 401(k) with 4% match, vested 100% from day one
• Employer-paid short and long-term disability
• Life insurance at 1x annual salary
• 20 days PTO + 10 Company Holidays & 2 Floating Holidays
• Paid new parent leave
• Additional benefits to be detailed in offer

What We Live By

We’re guided by our five core values:

Our Values:

• Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future.
• Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments.
• Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale.
• Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve.
• One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together.

We Value Diversity, Equity, Inclusion and Belonging

We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We’re proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.