Credentialing Manager

About the role

The Credentialing Manager oversees all provider credentialing, recredentialing, payer enrollment, and provider data management activities for Integrated Services for Behavioral Health (ISBH). This role ensures providers maintain active participation with various insurance plans while adhering to federal, state, accreditation, and payer-specific requirements.

Responsibilities

• Oversee all provider credentialing, recredentialing, payer enrollment, and provider data management activities for ISBH
• Manage the credentialing team and coordinate daily workflow to ensure the timely completion of credentialing activities
• Responsible for performance management, recruitment, onboarding, and team development, including implementing progressive discipline when necessary
• Ensure timely submission, tracking, and follow-up of credentialing and recredentialing applications to prevent lapses in provider participation
• Maintain provider credentialing files and databases, ensuring all licenses, certifications, registrations, and other required documentation remain current
• Serve as the primary resource for resolving complex credentialing and payer enrollment issues
• Ensure compliance with federal, state, accreditation, and payer-specific credentialing requirements
• Develop, implement, and maintain credentialing policies, procedures, and quality assurance standards
• Monitor credentialing performance metrics and identify opportunities for process improvement and operational efficiency
• Collaborate with billing, compliance, human resources, clinical leadership, and provider relations teams to support organizational goals
• Coordinate credentialing activities related to new programs, services, locations, and revenue streams
• Attend virtual and in-person internal and external training, conferences, and meetings as appropriate
• Participate in audits, accreditation reviews, and compliance activities as required
• Perform other duties as assigned

Requirements

• A high school diploma or GED equivalent
• A bachelor’s degree in business, Public Health, Healthcare Administration, or a related field is preferred
• 5 years of experience in provider credentialing and payer enrollment in a healthcare setting
• 3 years of supervisory or management experience in a healthcare credentialing role
• Experience with Ohio Medicaid provider enrollment and credentialing
• Experience working with credentialing systems and electronic health records
• Experience utilizing NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals

Qualifications

• Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance
• Advanced analytical, organizational, and problem-solving skills
• Proficiency with databases, spreadsheets, and Microsoft Office applications
• Advanced communication skills, both oral and written
• Advanced organizational skills
• Knowledge of local, state, and federal regulations
• The ability to maintain confidential information
• Ability to adhere to all safety rules, regulations, and requirements
• A valid driver's license and the ability to operate a motor vehicle
• An appropriate level of auto insurance coverage
• Ability to manage deadlines within a fast-paced, high-volume environment
• The ability to operate in an Internet-based, automated office environment
• The ability to maintain a high-speed internet connection

Skills

• Knowledge of credentialing regulations, payer requirements, provider enrollment processes, and industry best practices
• Ability to manage multiple projects, deadlines, and priorities independently
• Advanced analytical, organizational, and problem-solving skills
• Proficiency with databases, spreadsheets, and Microsoft Office applications
• Advanced communication skills, both oral and written
• Advanced organizational skills
• Knowledge of local, state, and federal regulations
• The ability to maintain confidentiality
• Ability to adhere to all safety rules, regulations, and requirements
• Ability to manage deadlines within a fast-paced, high-volume environment
• The ability to operate in an Internet-based, automated office environment
• The ability to maintain a high-speed internet connection

Benefits

Enjoy a great work environment with an excellent salary, generous paid time off, and a strong benefits package. Benefits include:

• Medical
• Dental
• Vision
• Short-term Disability
• Long-term Disability
• 401K with Employer Match
• Employee Assistance Program (EAP) providing support and resources to help you and your family with a range of issues

Pay

$87,000.00 to $108,000.00 annually, based on experience

Schedule

Virtual role