Credentialing Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the primary contact for designated clients, proactively addressing their inquiries and concerns.

• Organize regular meetings with clients to review provider enrollment and credentialing information, tackle challenges, and align on objectives.

• Monitor and assess KPIs such as retention/turnover rates, credentialing turnaround times, Network Adequacy, and Net Promoter Score.

• Manage provider enrollment, credentialing, and re-credentialing processes to ensure accuracy, timeliness, and compliance with payer requirements.

• Track, report, and document the status of enrollments, payer communications, and provider data across various systems.

• Serve as the primary resource for complex issues related to providers, payers, or claims.

• Identify and execute process enhancements to optimize workflows, shorten cycle times, and elevate the provider experience.

• Standardize standard operating procedures (SOPs), reporting frameworks, and quality controls within the Provider Relations team.

• Analyze trends, identify bottlenecks, and evaluate performance metrics to support decision-making and ongoing improvements.

• Assist in departmental strategy and scaling initiatives as the organization expands nationally.

• Collaborate with Revenue Cycle, Operations, Compliance, and Clinical Leadership teams.

• Provide executive-level updates and reports to leadership regarding provider enrollment status, associated risks, and capacity planning.

• Ensure clear and professional communication with providers and external partners.

⛳️ Requirements

• Minimum of 5 years of experience in provider relations, credentialing, enrollment, or healthcare operations.

• At least 2 years of experience in people management, which includes overseeing Team Leads or supervisors.

• A minimum of 2 years in account management or customer success, acting as the main point of contact for clients.

• Strong understanding of medical billing, payer enrollment processes, claims resolution, and healthcare workflows.

• Proven track record of leading teams, driving accountability, and implementing scalable processes.

• Bachelor’s degree is required.

• A degree in healthcare administration, business, or process improvement is preferred.

• Outstanding organizational, analytical, and reporting capabilities.

• Excellent communication skills with the ability to influence various levels and functions.

• Proficient in Microsoft Office Suite and credentialing/enrollment databases.

• Capacity to thrive in a fast-paced, high-growth environment with shifting priorities.

• Detail-oriented with strong problem-solving and decision-making skills.

🏝️ Benefits

• Company bonus programs for eligible employees.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• 401(k) plan.

• Paid time off.

• Comprehensive benefits package.