Credentialing Manager

Employment Type: Full-Time
Schedule: Monday–Friday, 8:00 AM–5:00 PM
Reports To: COO

POSITION SUMMARY

The Credentialing Manager is responsible for overseeing and managing the credentialing, recredentialing, enrollment, and compliance processes for Medi Trans’ transportation provider network. This position ensures that providers meet all applicable company, contractual, regulatory, and Medicaid requirements before and throughout their participation in the Medi Trans network.

The Credentialing Manager will provide leadership to the Credentialing Department, establish efficient workflows, monitor departmental productivity, ensure timely completion of credentialing requirements, and maintain accurate provider records.

The ideal candidate is highly organized, detail-oriented, accountable, and capable of managing a high-volume credentialing operation while maintaining confidentiality and regulatory compliance.

ESSENTIAL DUTIES AND RESPONSIBILITIESCredentialing & Provider Enrollment

• Oversee the complete credentialing and recredentialing process for NEMT providers.
• Ensure provider applications and supporting documentation are complete, accurate, and processed timely.
• Review provider documentation for compliance with Medi Trans, Medicaid, MCO, contractual, and regulatory requirements.
• Monitor provider licenses, certifications, insurance, vehicle documentation, background checks, and other required credentials.
• Ensure provider files remain current and complete throughout the provider's participation in the network.
• Manage initial credentialing, recredentialing, provider updates, terminations, and other credentialing activities.
• Coordinate with providers to obtain missing, expired, or incomplete documentation.
• Maintain accurate credentialing records and documentation in applicable systems.

Department Management

• Supervise, train, coach, and provide direction to Credentialing Department and Field Service Specialist employees.
• Establish clear departmental expectations, procedures, deadlines, and performance standards.
• Monitor employee productivity, accuracy, attendance, and quality of work.
• Conduct regular quality reviews and identify opportunities for improvement.
• Hold team members accountable for completing assigned work within established deadlines.
• Assist with hiring, onboarding, training, and performance management of Credentialing Department employees.
• Develop cross-training procedures to maintain department continuity.

Compliance & Quality Assurance

• Ensure credentialing practices remain compliant with applicable Louisiana Medicaid, MCO, contractual, and regulatory requirements.
• Monitor credentialing files for accuracy and completeness.
• Conduct routine audits of provider files and credentialing documentation.
• Identify deficiencies and implement corrective actions when necessary.
• Maintain appropriate documentation for internal and external audits.
• Ensure confidential provider and company information is handled appropriately.
• Escalate compliance concerns and credentialing issues to appropriate leadership.

Reporting & Performance Management

• Prepare and maintain credentialing reports, tracking logs, and departmental metrics.
• Monitor outstanding applications, pending documentation, expirations, and recredentialing deadlines.
• Provide leadership with regular updates regarding department workload, productivity, and outstanding issues.
• Track turnaround times and identify delays or bottlenecks.
• Develop and maintain procedures designed to improve departmental efficiency and accuracy.

Provider Communication

• Serve as a point of escalation for complex provider credentialing matters.
• Communicate professionally with transportation providers regarding credentialing requirements and deficiencies.
• Explain credentialing requirements and assist providers with resolving documentation issues.
• Work closely with Provider Network, Field Service Specialist and other departments to ensure smooth provider onboarding and maintenance.

Other Responsibilities

• Maintain strict confidentiality of company, employee, provider, and member information.
• Protect sensitive and confidential information in accordance with Medi Trans policies and applicable requirements.
• Participate in departmental and leadership meetings as requested.
• Assist with special projects and process-improvement initiatives.
• Perform other duties as assigned by leadership.

REQUIRED QUALIFICATIONS

• High school diploma or equivalent required; associate or bachelor's degree preferred.
• Previous experience in credentialing, provider enrollment, healthcare administration, NEMT, Medicaid, managed care, or a related field.
• Previous supervisory or management experience preferred.
• Strong knowledge of credentialing and provider enrollment processes.
• Strong organizational and time-management skills.
• Excellent written and verbal communication skills.
• Strong attention to detail and accuracy.
• Ability to manage multiple priorities and meet deadlines.
• Proficiency with Microsoft Office and computer-based administrative systems.
• Ability to maintain strict confidentiality.
• Ability to work independently while also leading and supporting a team.

PREFERRED EXPERIENCE

• Experience working with Louisiana Medicaid and/or Medicaid Managed Care Organizations.
• Experience with NEMT provider credentialing.
• Experience with provider enrollment and recredentialing.
• Experience conducting credentialing audits.
• Experience managing a high-volume credentialing department.
• Experience developing departmental policies, procedures, and tracking systems.

KEY PERFORMANCE EXPECTATIONS

The Credentialing Manager is expected to:

• Maintain accurate and complete provider credentialing files.
• Ensure credentialing and recredentialing deadlines are consistently met.
• Minimize expired or missing provider documentation.
• Maintain strong departmental productivity and accuracy.
• Ensure employees follow established credentialing procedures.
• Identify and resolve credentialing issues promptly.
• Maintain compliance with applicable requirements.
• Provide reliable and timely reporting to leadership.
• Foster accountability, professionalism, and teamwork within the Credentialing Department.

CONFIDENTIALITY

Due to the nature of this position, the Credentialing Manager will have access to confidential business, provider, employee, and potentially protected information. The employee is expected to maintain strict confidentiality and comply with all Medi Trans confidentiality, privacy, security, and information-handling policies. Confidential information may not be discussed, accessed, copied, or shared except as authorized and required to perform job responsibilities.

COMPENSATION

Medi Trans offers a comprehensive benefits package in accordance with the company's current benefits plan, including applicable health and welfare benefits, paid time off, holidays, and retirement benefits.

EQUAL EMPLOYMENT OPPORTUNITY

Medi Trans, LLC is an equal opportunity employer. Employment decisions are made based on qualifications, business needs, and organizational requirements without regard to legally protected characteristics.

This job description is intended to describe the general nature and level of work performed by employees in this position. It is not intended to be an exhaustive list of all duties, responsibilities, or qualifications. Duties may be modified or assigned as business needs require.

Pay: $55,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Education:

• Associate (Required)

Experience:

• Credentialing: 3 years (Required)
• Management: 2 years (Required)

Location:

• Lafayette, LA 70508 (Preferred)

Work Location: In person

Salary : $55,000 - $60,000