Manager, Network Integrity

The Manager of Network Integrity is a critical leadership role responsible for steering the credentialing, compliance, and Medicaid growth strategy for our DMEPOS operations. The position will lead credentialing staff and a contract advisor responsible for payer contracting and network management activities, ensuring alignment between credentialing, legal, and payer relations functions. They will oversee the end-to-end credentialing lifecycle, balancing day-to-day operational excellence with overarching strategic initiatives.

Furthermore, the Manager of Network Integrity will spearhead our strategy to expand our Medicaid Fee-for-Service (FFS) and Managed Care footprint, acting as the crucial connective tissue bridging our Network Management and Revenue Cycle teams.

• Oversee and direct all day-to-day credentialing, re-credentialing, and enrollment activities for the organization, ensuring accuracy and timely completion.
• Develop, implement, and continuously refine the overarching credentialing strategy to align with the company's growth objectives and operational capabilities.
• Maintain a robust quality assurance process for all credentialing files and provider databases to ensure audit-readiness and compliance with state, federal, and payer-specific standards.
• Optimize internal reporting mechanisms to ensure credentialing and network data visibility meets the specific needs of various internal stakeholders, including Legal, Compliance, and Revenue Cycle Management.
• Translate complex regulatory changes into actionable operational guidelines for internal teams to prevent claim denials and ensure revenue integrity.
• Lead the strategic planning and execution efforts to grow the company's Medicaid Fee-for-Service and Managed Care organization footprint.
• Identify new market opportunities and guide the team through the application and contracting processes required to enter new networks.
• Partner with leadership to assess the financial and operational viability of entering new Medicaid markets.
• Serve as the primary liaison connecting internal dots between the Network Management, Contracting, Revenue Cycle (RCM), and Market Access Sales departments.
• Proactively collaborate with RCM leaders to troubleshoot front-end credentialing issues that impact back-end billing and cash flow.
• Lead cross-functional meetings to ensure all stakeholders are aligned on network status, risk updates, and process improvements that affect the organization's bottom line.

• Bachelor's degree or equivalent experience preferred.
• 5+ years of experience in credentialing, network management, or provider enrollment, with a strong preference for candidates who have managed these processes within the Durable Medical Equipment (DME), Home Medical Equipment (HME), or DMEPOS industry strongly preferred.
• Relevant experience in the payer space a plus.
• Proven leadership experience with a demonstrated ability to coach, mentor, and develop others. Must possess a strong "player-coach" mentality—capable of guiding strategic initiatives and empowering team members while remaining willing to roll up your sleeves and support day-to-day credentialing operations.
• Proven ability to design, build, and execute a comprehensive strategic roadmap for credentialing operations and network footprint expansion that aligns with overarching organizational goals.
• Strong analytical capabilities with a demonstrated ability to analyze complex operational metrics and synthesize them into clear, actionable insights and strategic recommendations for executive leadership.
• Exceptional written, verbal, and presentation skills, with experience presenting complex operational and regulatory strategies to senior leadership, cross-functional partners, and external stakeholders.
• Deep subject matter expertise in Medicaid policy and administrative guidelines, with a proven track record of effectively researching, interpreting, and applying state-specific Medicaid billing and enrollment requirements.
• Proven success in spearheading network growth strategies, specifically demonstrating experience in expanding Medicaid Fee-for-Service (FFS) and Managed Care Organization (MCO) footprints across multiple markets or states.
• Comprehensive knowledge of federal and state healthcare compliance standards, accreditation guidelines and quality assurance related to provider credentialing and network integrity.

• Manages department operations and supervises professional employees, front line supervisors and/or business support staff.
• Participates in the development of policies and procedures to achieve specific goals.
• Ensures employees operate within guidelines.
• Decisions have a short term impact on work processes, outcomes and customers.
• Interacts with subordinates, peers, customers, and suppliers at various management levels; may interact with senior management.
• Interactions normally involve resolution of issues related to operations and/or projects.
• Gains…