Credentialing Manager

Position Summary

The Credentialing Manager is responsible for overseeing all provider credentialing, recredentialing, enrollment, and privileging activities to ensure compliance with regulatory, accreditation, payer, and organizational requirements. This role manages the credentialing team, develops and maintains credentialing policies and procedures, and ensures providers are credentialed and enrolled accurately and timely to support uninterrupted patient care and revenue cycle operations.

Essential Duties and Responsibilities

Credentialing Operations

• Manage the end-to-end credentialing and recredentialing process for healthcare providers, including physicians, advanced practice providers, behavioral health providers, and allied health professionals.
• Oversee provider enrollment, revalidation, and maintenance with commercial payers, Medicare, Medicaid, and other governmental programs.
• Ensure all credentialing files are complete, accurate, and maintained according to organizational policies and regulatory standards.
• Monitor credential expiration dates and ensure timely renewals for licenses, certifications, DEA registrations, malpractice insurance, and other required documentation.
• Maintain records and credentialing databases with accurate and up-to-date information.

Compliance and Quality Assurance

• Develop, implement, and maintain credentialing policies, procedures, and internal controls.
• Conduct regular audits of credentialing files and processes to ensure quality and compliance.
• Prepare reports and documentation for accreditation surveys, audits, and regulatory reviews.

Leadership and Team Management

• Supervise, mentor, and evaluate credentialing specialists and support staff.
• Establish departmental goals, performance standards, and productivity metrics.
• Identify training needs and provide ongoing education to team members.
• Foster a culture of accountability, customer service, and continuous improvement.

Provider and Stakeholder Relations

• Serve as the primary resource for providers, management, client representatives and external agencies regarding credentialing matters.
• Collaborate with practice leadership and revenue cycle teams.
• Resolve credentialing issues that may delay provider onboarding, enrollment, or reimbursement.

Process Improvement

• Evaluate and improve credentialing workflows, systems, and technologies.
• Implement best practices to increase efficiency, accuracy, and turnaround times.
• Develop reporting tools and dashboards to monitor credentialing status and departmental performance.

Required Qualifications

• Minimum of 5 years of healthcare credentialing experience.
• Minimum of 2 years of supervisory or management experience.
• Strong knowledge of provider credentialing, payer enrollment, and healthcare regulations.
• Experience working with credentialing software, MedTrainer a plus, and provider databases.
• Proficiency in Microsoft Office Suite, especially Excel and reporting tools.

Knowledge, Skills, and Abilities

• In-depth knowledge of credentialing, privileging, and provider enrollment processes.
• Strong leadership and team management skills.
• Excellent organizational and project management abilities.
• Ability to manage multiple deadlines and priorities simultaneously.
• Strong analytical and problem-solving skills.
• Excellent written and verbal communication skills.
• High attention to detail and accuracy.
• Ability to maintain confidentiality and handle sensitive information.

Key Performance Indicators (KPIs)

• Credentialing completion turnaround times.
• Provider enrollment approval timelines.
• Credentialing file audit accuracy rates.
• Recredentialing completion rates.
• Compliance with regulatory and accreditation standards.
• Team productivity and service-level benchmarks.

Reporting Relationship

Reports To: Executive Director

Supervises: Credentialing Specialists, Provider Enrollment Specialists, and Credentialing Coordinators

Work Environment: Remote