Credentialing Manager

This is a fully remote position, open to applicants in Alaska, +10 more states.

📋 Description

• Lead, manage, and develop a team of over 5 credentialing specialists, taking ownership of team KPIs which include enrollment turnaround times as well as the number of applications submitted and approved.

• Take charge of the end-to-end delegated credentialing program, encompassing provider onboarding, primary source verification, and upholding NCQA-aligned standards.

• Head the internal credentialing committee — presenting cases, maintaining meeting minutes, and overseeing approvals.

• Manage necessary payor audits and internal audits to ensure continued compliance with NCQA and delegated credentialing standards.

• Establish and drive a long-term credentialing strategy, collaborating with Commercial Strategy to enhance delegated credentialing statuses across payors.

• Create and maintain a centralized “Credentialing Source of Truth” that documents payor-specific requirements (such as provisional credentialing, SLAs, backdating policies, etc.).

• Partner with RevOps to synchronize on KPIs and incentive structures, and work with RCM to resolve issues with payors and credentialing-related denials.

• Identify and implement process enhancements that boost team efficiency, including automation and AI-enabled workflows.

• Oversee daily payor and Medicaid enrollment for both group and individual submissions, ensuring timely, accurate, and compliant applications tracked in Salesforce.

⛳️ Requirements

• Bachelor's degree.

• Over 5 years of experience in provider credentialing and/or health plan enrollment.

• Direct, hands-on experience in owning or operating a delegated credentialing program is essential, including primary source verification, credentialing committee operations, and NCQA standards.

• At least 2 years of people management experience leading a credentialing or enrollment team is preferred.

• Experience with both Medicaid and Commercial payor enrollment.

• Proven ability in process improvement and a history of utilizing automation and emerging technologies (including AI) to streamline operations.

• Strong cross-functional collaboration abilities across RevOps, RCM, Commercial Strategy, and Compliance.

• Authorization to work in the United States and native or bilingual proficiency in English.

• Familiarity with and readiness to use cloud-based communication tools — Google Suite, Slack, Zoom, Dropbox, Salesforce.

🏝️ Benefits

• Comprehensive benefits offered to all full-time, exempt employees.