Credentialing Manager

Position Summary

The Credentialing Manager serves as the operational partner to credentialing leadership by managing day-to-day credentialing and enrollment activities, team performance, and workflow optimization. This role focuses on improving efficiency, implementing automation, and ensuring timely provider onboarding and compliance.

Key Responsibilities

• Manage day-to-day credentialing and payer enrollment operations, ensuring timely completion of provider applications and renewals.
• Monitor department productivity, application status, enrollment aging, and onboarding timelines.
• Develop and maintain operational reports, dashboards, and KPI tracking tools.
• Standardize credentialing processes, maintain SOPs, and identify opportunities to reduce delays and improve efficiency.
• Train, mentor, and support credentialing staff while ensuring adherence to payer and regulatory requirements.
• Cook up escalations with payers, providers, and internal stakeholders to resolve enrollment issues.
• Serve as the operational partner to the Director by leading process improvements and executing department initiatives.

Ai & Automation Responsibilities

• Automate provider status updates, enrollment tracking, and stakeholder communications.
• Implement automated alerts for expiring licenses, certifications, malpractice coverage, and payer renewals.
• Develop AI-assisted dashboards that monitor application progress, aging, and team productivity.
• Utilize automation tools to reduce manual document collection, tracking, and reporting activities.

Requirements

• Minimum Requirements: Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or related field preferred. Minimum 5 years of provider credentialing and payer enrollment experience. Strong knowledge of CAQH, Medicare, Medicaid, commercial payer enrollment, and provider licensing requirements. Experience managing credentialing workflows, productivity metrics, and provider onboarding timelines. Proficiency with credentialing software, reporting tools, and document management systems.

Benefits

• Health
• Dental
• Vision
• 401(k) & Match
• Paid time off