Credentialing Manager

About the role

We are seeking a Credentialing Manager for Integrated Services for Behavioral Health (ISBH). This role is based in Southeastern, OH (virtual).

Responsibilities

• Oversee all provider credentialing, recredentialing, payer enrollment, and provider maintenance 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 but not limited to 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
• Monitor provider enrollment status with Ohio Medicaid, Medicare, commercial payers, and other contracted entities
• 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
• Maintain expertise in credentialing regulations, payer requirements, provider enrollment processes, and industry best practices
• Coordinate credentialing activities related to new programs, services, locations, and revenue streams
• Participate in audits, accreditation reviews, and compliance activities as required
• Attend virtual and in-person internal and external training, conferences, and meetings as appropriate
• Maintain compliance with HIPAA, mandated reporting requirements, and professional ethical guidelines
• Travel within the designated service area
• Perform other duties as assigned

Requirements

• Education/Licensure: A high school diploma or GED equivalent is required. A bachelor’s degree in business, public health, healthcare administration, or a related field is preferred.
• Experience: 5 years of experience in provider credentialing and payer enrollment in a healthcare setting is required. 3 years of supervisory or management experience in a healthcare credentialing role is required. Experience with Ohio Medicaid provider enrollment and credentialing is required. Experience working with credentialing systems and electronic health records is required. Experience utilizing NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals is required.
• Knowledge, Skills, and Abilities: Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance. 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 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.

Qualifications

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

Skills

• Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance
• 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

Benefits

• Medical
• Dental
• Vision
• Short-term Disability
• Long-term Disability
• 401K with Employer Match
• Employee Assistance Program (EAP)