Managed Provider Relations and Credentialing departments which had a staff of seven Provider Relations Representatives, two Credentialing Coordinators, and one Health Provider Network (HPN) Coordinator. Recruited and trained staff on business rules, provider systems, and site visits for plan compliance. Developed provider orientation and education materials for enrollment to Child Health Plus, Medicaid and Family Health Plus.Identified provider deficiencies within Plan service area and negotiated needed contracts. Oversaw the timely submission of the Provider Satisfaction surveys and HPN filing to regulatory agencies. Development and primary testing lead for the $1.2 million enterprise-wide data system for the management of claims processing, credentialing, and directory production for 3 Royal’s clients.Oversaw the production of the Provider Directory for 5 clients; developed workflows for efficient and timely completion of projects. Directly responsible for filing of the Health Provider Network (HPN) for five Managed Care Plans with excellent outcomes for all submissions.Maintained oversight of 42 delegated hospitals by performing on-site review of credentialing/ recredentialing delegation oversight processes; Continuous management of credentialing/recredentialing process for over 10,000 Medicaid, Child Health Plus, and Family Health Plus providers for 3 Royal’s clients according to NCQA standards and as a result 8 straight years of excellent review. Contract negotiations for Plan providers and load contract rates to claims processing system. Developed audit tools to assure the accuracy of the provider files. Identified obstacles presented by contracted providers and developed action plans to ensure compliance. Developed and maintained policies and procedures as appropriate to meet clients and/or Department of Health standards.