Credentialing Manager

POSITION SUMMARY: The Credentialing Manager is responsible for overseeing all aspects of payer enrollment, recredentialing, and ongoing maintenance of provider participation in insurance networks. This role ensures compliance with regulatory requirements and payer-specific standards, while streamlining credentialing processes to support rapid onboarding of new providers and locations across the organization.

Location: Wabash, IN 

ESSENTIAL RESPONSIBILITIES:

• Credentialing & Enrollment Oversight

o Manage and execute the end-to-end credentialing lifecycle (initial credentialing, recredentialing, and expirable tracking).

o Oversee payer enrollment applications, PECOS updates, CAQH maintenance, NPPES records, and delegated agreements.

o Monitor and ensure compliance with NCQA, CMS, and commercial payer standards.

o Maintain an accurate credentialing database.

• Team & Process Management

o Lead and mentor a credentialing team, ensuring timely submission and follow-up of applications.

o Establish, document, and refine credentialing workflows, SOPs, and KPIs.

o Collaborate with HR, operations, and revenue cycle teams.

• Payer & Regulatory Communication

o Act as a primary liaison with insurance plans to resolve enrollment delays or issues.

o Stay current with payer policy updates and state/federal regulations.

o Support audits related to credentialing files.

• Reporting & Metrics

o Provide weekly and monthly updates on credentialing status and turnaround times.

o Track and report on expirable to avoid lapses.

o Prepare credentialing rosters and enrollment summaries.

CORE EXPECTATIONS:

• Strategic Development:

o Be a champion of the company’s overall culture and commitment to patient care.

o Align patient care and practice model development goals with resource development.

• Performance Management:

o Maintain compliance with the organization’s policies and applicable regulatory guidelines.

EDUCATION AND/OR EXPERIENCE:

Required:

• Bachelor’s degree or equivalent experience.
• 3–5 years of credentialing experience; 2 years in a supervisory role.
• Knowledge of Medicare/Medicaid enrollment, CAQH, PECOS, NPPES systems.
• Strong attention to detail and communication skills.
• Proficiency with Excel and credentialing software.

Preferred:

• Experience in optometry, ophthalmology, or outpatient healthcare. Job Description and Responsibilities 
• Familiarity with delegated credentialing and managed care contracting.
• CPCS or CPMSM certification.

Skills:

• Strong understanding of CPT, ICD-10, and HCPCS codes relevant to ophthalmology and optometry.
• Knowledge of insurance guidelines for procedures, diagnostics, and modifiers specific to eyecare.
• Detail-oriented with excellent organizational and problem-solving skills.
• Strong communication and leadership skills to manage staff and coordinate with multiple departments.
• Ability to manage deadlines, multi-task, and resolve billing issues quickly and accurately.

COMPETENCIES:

• Leadership
• Strategic Thinking
• Problem Solving/Analysis
• Proficient in Microsoft software
• Presentation Skills
• Technical Capacity
• Organizational Skills
• Communication Skills

PHYSICAL DEMANDS AND WORK ENVIRONMENT (per ADA guidelines):

• Physical Activity: Talking, walking, hearing, repetitive motion.
• Physical Requirements: Sedentary work.
• The worker is required to have visual acuity to determine accuracy, neatness, and thoroughness of the work assigned.
• Travel could be required for this position and requires a valid driver’s license.