Credentialing Manager

POSITION SUMMARY: The Credentialing Manager is responsible for overseeing all aspects of payer enrollment, recredentialing, and ongoing maintenance of provider participation in insurance networks. This role ensures compliance with regulatory requirements and payer-specific standards, while streamlining credentialing processes to support rapid onboarding of new providers and locations across the organization. Wage will be determined based on knowledge, skills, and experience Remote position Essential Responsibilities Credentialing & Enrollment OversightManage and execute the end-to-end credentialing life cycle (initial credentialing, recredentialing, and expiration tracking)Oversee payer enrollment applications, PECOS updates, CAQH maintenance, NPPES records, and delegated agreementsMonitor and ensure compliance with NCQA, CMS and commercial payer standardsMaintain an accurate credentialing databaseTeam & Process ManagementLead, supervise, and support team of Provider Enrollment Specialists, ensuring timely submission and follow-up of applicationsEstablish, document, and refine credentialing workflows, SOPs, and KPIsPayer & Regulatory CommunicationAct as primary liaison with insurance plans to resolve enrolment delays or issuesStay current with payer policy updates and state/federal regulationsSupport audits related to credentialing filesReporting & MetricsProvide weekly and monthly updates on credentialing status and turnaround timesTrack and report on pending expirations to avoid lapsesPrepare credentialing rosters and enrollment summariesPerform other duties as assigned Core Leadership Expectations Strategic Development:Be a champion of the company's overall culture and commitment to patient care.Align strategic goals and resources to maximize profitability.Collaborate across the organization to identify needs and develop scalable solutions.Work on integration and post-acquisition teams as needed.Performance Management:Drive operational excellence to achieve the organization’s financial goals.Maintain compliance with the organization’s policies and applicable regulatory guidelines. Staff Development:Build and lead creative, collaborative teams; develop people; and link performance to overall business objectives.Guide and evaluate the work of other employees, including peers, to ensure a healthy working environment.Proactively recruit, hire, train, motivate and retain current and future leaders. Education, Experience, And Certification Bachelor’s degree or equivalent experience required3-5 years of credentialing experience; 2+ years in a supervisory roleExperience in optometry/ophthalmology or outpatient healthcare preferredExperience in delegated credentialing and/or managed care contracting preferredCPCS or CPMSM certification preferred Competencies Strategic Relationship ManagementAdvanced Communication SkillsInfluence & Negotiation SkillsCross-Functional CollaborationProcess Improvement & Problem SolvingProject & Time ManagementProficiency in Microsoft OfficeStrong knowledge of CPT, ICD-10, and HCPCS codes relevant to optometry/ophthalmologyKnowledge of insurance guidelines relevant to optometry/ophthalmologyAttention to detailProfessional Integrity PHYSICAL DEMANDS AND WORK ENVIRONMENT (per ADA Guidelines) Physical Demands:Sedentary work requiring prolonged periods of sitting at a computer workstationRegular use of hands and fingers for keyboarding and other standard office equipmentAbility to communicate effectively through verbal and written meansAbility to hear and understand spoken information in-person and via electronic meansVisual acuity to ensure the accuracy of work performed on screens and in documentsAbility to maintain focus and attention to detail for extended periodsWork Environment: This position is based in a professional office and/or remote office setting that consists of a climate-controlled indoor environment with standard office noise levels that utilizes computers, phones, and related technology.Reasonable accommodations may be provided to qualified individuals with disabilities to enable performance of essential job functions, in accordance with applicable laws. This job description reflects the essential functions of the position and is not intended to be a comprehensive inventory of all duties, responsibilities, qualifications, or working conditions. Management reserves the right to modify, add, or remove duties at any time, with or without notice, consistent with applicable law. Nothing in this job description constitutes an employment contract or agreement or guarantee of continued employment.