Sr. Manager of Credentialing and Contracting

Position Overview

The Senior Manager of Credentialing and Contracting will oversee provider credentialing, payer enrollment, and payer contracting operations across a growing multi-state healthcare organization. This role requires someone who understands the full connection between credentialing, contracting, payer enrollment, provider readiness, revenue cycle, and business growth.

Key Responsibilities

• Manage provider credentialing, recredentialing, payer enrollment, facility credentialing, and related compliance processes across multiple states.
• Oversee enrollment activities with Medicare, Medicaid, managed Medicaid, Medicare Advantage, commercial payers, and other payer partners.
• Support the pursuit of new payer contracts to align with BHS’ growth, new market expansion, and service line development.
• Aid in reviewing, negotiating, and tracking payer contract terms, reimbursement rates, fee schedules, administrative requirements, timely filing provisions, credentialing timelines, and renewal or termination language.
• Manage provider and entity enrollment through CAQH, PECOS, NPI, Medicaid portals, payer applications, and other required platforms.
• Maintain accurate and organized credentialing files, payer enrollment records, payer contracts, amendments, fee schedules, renewal dates, and payer requirements.
• Track credentialing timelines, payer enrollment status, contract status, recredentialing deadlines, revalidation dates, and provider billing readiness.
• Partner closely with direct leadership, revenue cycle, operations, finance, compliance, and clinical leadership to ensure providers are ready to deliver services and bill appropriately.
• Identify, research, and resolve credentialing, enrollment, payer setup, denial, reimbursement, and contract interpretation issues.
• Create and maintain SOPs, tracking tools, dashboards, reports, and escalation workflows to support consistency and accountability.
• Monitor payer requirements and communicate changes that may impact enrollment, credentialing, contracting, billing, or operational readiness.
• Serve as a key internal resource for credentialing, payer enrollment, Medicare, Medicaid, payer contracting, and payer participation requirements.

Qualifications

• Bachelor’s degree in healthcare administration, business administration, or a related field preferred; equivalent experience may be considered.
• Minimum of 5–7 years of progressive experience in healthcare credentialing, payer enrollment, payer contracting, provider enrollment, or a closely related function.
• Experience working directly with payer representatives required.
• Experience with Medicare and Medicaid enrollment required.
• Experience supporting payer contract review, payer negotiations, or rate discussions strongly preferred.
• Multi-state healthcare experience strongly preferred.
• CPCS, CPMSM, or similar credentialing certification preferred but not required.