Credentialing Manager (Provider Enrollment)

Job Description

Manager of Credentialing (Provider / Payer Enrollment)

About the Role

A large, multi-state healthcare organization is seeking an experienced and proactive Manager of Credentialing (Provider / Payer Enrollment) to oversee credentialing operations for a growing network of nearly 200 providers. This position plays a key role in ensuring timely payer enrollment and regulatory compliance across Medicare, Medicaid, and commercial payers.

The ideal candidate is a hands-on working manager who can lead a credentialing team while also directly managing day-to-day operations such as payer enrollment, revalidation, and license verification. This role requires someone who can quickly assess existing workflows, identify gaps, and implement process improvements that enhance accuracy and turnaround times.

Key Responsibilities

• Oversee all aspects of provider credentialing and payer enrollment, including new applications, revalidations, and commercial payer participation.
• Manage and mentor credentialing staff, ensuring performance goals, compliance, and quality standards are met.
• Utilize credentialing software to track, maintain, and automate workflows and expirables.
• Develop, monitor, and report on key performance indicators such as turnaround times and enrollment completion rates.
• Identify and implement process improvements to streamline operations and increase efficiency.
• Serve as the escalation point for credentialing and enrollment issues, ensuring timely resolution with payers, providers, and internal teams.
• Collaborate with leadership, revenue cycle, and operations teams to align credentialing efforts with organizational objectives.

Qualifications

Required :

Preferred :

Work Environment & Schedule

Why This Role is Exciting