Credentialing Manager

As a member of the Credentialing Team you guide and oversee the provider onboarding and re-credentialing processes that are vital to expanding and maintaining access to care. You understand that credentialing is more than checking boxes it is about ensuring families can begin services on time providers can deliver care without interruption and the organization remains in full compliance with payer and regulatory requirements.

Your leadership ensures that details are managed consistently deadlines are met and team members are supported in their day-to-day work. By building efficient systems resolving escalated issues and maintaining strong payer relationships you safeguard the organizations ability to grow its provider network welcome new families and continue delivering high-quality care.

Key Responsibilities:

• Lead and oversee all credentialing and re-credentialing processes to ensure providers are fully authorized to deliver care within established timelines.
• Develop implement and maintain credentialing policies procedures and workflows that ensure accuracy consistency and compliance.
• Prepare review and submit credentialing applications ensuring 95% are accepted on first submission.
• Communicate in an effective timely and professional manner with clinicians/providers including both new hires and current team members. Be able to answer questions and support clinicians in submitting all necessary credentialing paperwork.
• Monitor credentialing turnaround times achieving 30 days for re-credentialing and 90 days for new providers.
• Manage payer rosters and internal systems to maintain 98% provider directory accuracy.
• Manage provider systems and data including NPI numbers CAQH profiles Medicaid portals and other supportive tasks to ensure credentialing stays accurate and current.
• Serve as the escalation point for complex or delayed credentialing issues engaging directly with payers and regulatory agencies as needed.
• Collaborate with Contracting Billing and AR teams to ensure credentialing data is correctly implemented and prevents claim denials.
• Provide regular reporting to leadership on credentialing performance metrics compliance status and provider network growth.
• Support and mentor team members (including a Credentialing Coordinator direct report if applicable) fostering accuracy accountability and professional development.
• Maintain detailed and organized documentation of applications payer communications and compliance activities for audit readiness.
• Identify and implement process improvements to streamline credentialing workflows and strengthen compliance. Use all internal systems proficiently and build new systems as needed.
• Build and maintain relationships with payer credentialing departments and be able to contact payers directly to resolve issues.
• Ensure adherence to HIPAA payer and regulatory requirements at all times.

Performance Metrics:

• Provider Credentialing Turnaround: 30 days for re-credentialing 90 days for new providers
• Clean Credentialing Application Submission Rate: >95% of applications accepted on first submission
• Provider Directory Accuracy: 98% accuracy across payer rosters and internal systems
• Error Prevention: All RCM teams routinely identify and fix root causes preventing recurring denials

Desired Qualifications and Experience:

• Bachelors degree in healthcare administration business or related field preferred.
• Minimum 35 years of experience in provider credentialing payer enrollment or healthcare compliance.
• Strong knowledge of payer credentialing requirements CAQH NPI Medicaid/Medicare enrollment and regulatory compliance standards.
• Proven ability to manage credentialing lifecycles with accuracy and efficiency.
• Demonstrated success achieving high clean submission rates and fast turnaround times.
• Strong organizational skills with the ability to manage multiple applications rosters and deadlines simultaneously.
• Excellent communication and relationship-building skills for interactions with payers providers and internal teams.
• Proficiency with credentialing databases RCM/EHR systems and Microsoft Office Suite.
• High attention to detail and commitment to accuracy and compliance.
  Strong problem-solving skills and persistence in resolving escalated issues.

Essential Job Functions

• Must have manual dexterity to perform specific computer and electronic device functions
• Must have visual acuity to read and comprehend written communication though computer electronic devices and paper means.
• Must be able to maintain prolonged periods of working on a computer while sitting at a desk and attending virtual meetings

Job Type: Non-Exempt Full-Time

Pay is competitive and based on candidate qualifications and experience. Full-time employees will be offered our comprehensive benefits including Paid Time Off 401k insurance (health dental and vision) and the option of Short and Long-Term disability insurance.

About Bierman Autism Centers:

Our goal is to fuse science and learning to accelerate progress and transform lives. We were established in 2006 with a simple focus on providing excellent therapy for children with autism and building a unique and fun environment for team members and children to thrive. We live by the culture weve created and our core values: to create a fun and stimulating learning environment empower individuals and treat them with kindness integrity and respect never sit still achieve and continuously raise the bar team above the individual build a sustainable organization that leaves a meaningful impact on lives and adhere to our core principles without compromise.

Bierman Autism Centers values diversity in the workplace. The company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience training education and ability to do the available work without regard to race religion color age sex/gender sexual orientation national origin gender identity disability marital status veteran status genetic information ancestry or any other status protected by law.

Furthermore Bierman Autism Centers is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin race color religion gender ancestry age sexual orientation gender identity disability marital status veteran status genetic information or any other status protected by law.

As an equal opportunity employer Bierman Autism Centers does not discriminate against qualified individuals with disabilities. If you require a reasonable accommodation as a candidate for employment please inform a member of the Talent Acquisition team.