Credentialing Manager
Credentialing Manager
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Key Responsibilities
- Credentialing & Compliance
- Lead endtoend 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
- Payer Enrollment
- 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 uptodate on changes in payer requirements and documentation standards
- Process Optimization
- 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 fastpaced multistate environment
KPIs
- Credentialing Turnaround Time 30 days from complete application submission
- Payer Enrollment Completion Rate 90% completed within 4560 days depending on payer and state
- Provider Satisfaction >90% positive feedback on onboarding and credentialing support
Qualifications
- 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
- Detailoriented deadlinedriven 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
Benefits
- Full healthcare coverage with Anthem BCBS (or similar) with dental and vision
- Employee contribution to 401(k) retirement plan
- Paid Time Off (PTO) accrual policy of 1.7 working days per month
- Paid education/professional development stipend of up to $2500 per year based on approval
- Collaborative environment working directly with designers engineers scientists and clinicians
Required Experience:
Manager
Employment Type
Full-Time
