Credentialing Manager

Credentialing Manager

Requirements

• 5+ years of experience in healthcare credentialing and payer enrollment
• CPCS or CPMSM certification preferred
• Strong understanding of credentialing standards (CMS, NCQA) and payer processes
• Proficiency with CAQH, PECOS, and payer portals
• Detail-oriented, deadline-driven, and capable of managing multiple priorities
• Comfort using technology such as Google Suite, Slack, CAQH, PECOS, and payer portals
• Comfortable in a dynamic and always evolving start up environment

Responsibilities

• Lead end-to-end provider credentialing and recredentialing processes across all markets
• Conduct primary source verification for licenses, education, board certifications, and malpractice history
• Maintain complete, accurate provider records across internal systems and CAQH
• Monitor expirables such as licenses, DEA, board certs, and malpractice insurance
• Identify and document adverse actions or red flags for internal review
• Act as the primary contact for credentialing status between internal teams, providers, and payers
• Manage provider enrollment with Medicare, Medicaid, and commercial insurers
• Complete and submit enrollment forms including 855I, 855B, and 855R
• Track enrollment status through PECOS, CAQH, and payer portals
• Resolve delays, denials, or RFIs to avoid billing or onboarding disruptions
• Communicate enrollment progress to Recruiting, Billing, and Clinical Operations teams
• Stay up-to-date on changes in payer requirements and documentation standards
• Use PECOS, CAQH, and payer portals to track credentialing and enrollment workflows
• Implement best practices to reduce turnaround time and improve accuracy
• Monitor SLAs and KPIs and drive continuous process improvement
• Support the scalability of credentialing operations in a fast-paced, multi-state environment

Preferred Qualifications

• CPCS or CPMSM certification preferred