Credentialing Manager

This is a fully remote position, open to applicants in Ohio, +1 more state.

📋 Description

• Oversee all provider credentialing, recredentialing, payer enrollment, and provider maintenance activities for ISBH.

• Manage the credentialing team and coordinate daily workflows to ensure timely completion of credentialing activities.

• Responsible for performance management, recruitment, onboarding, and team development, which includes implementing progressive discipline when necessary.

• Ensure timely submission, tracking, and follow-up of credentialing and recredentialing applications to prevent lapses in provider participation.

• Maintain provider credentialing files and databases, ensuring all licenses, certifications, registrations, and other required documentation are current.

• Monitor provider enrollment status with Ohio Medicaid, Medicare, commercial payers, and other contracted entities.

• Serve as the primary resource for resolving complex credentialing and payer enrollment issues.

• Ensure compliance with federal, state, accreditation, and payer-specific credentialing requirements.

• Develop, implement, and maintain credentialing policies, procedures, and quality assurance standards.

• Monitor credentialing performance metrics and identify opportunities for process improvement and operational efficiency.

• Collaborate with billing, compliance, human resources, clinical leadership, and provider relations teams to support organizational goals.

• Maintain expertise in credentialing regulations, payer requirements, provider enrollment processes, and industry best practices.

• Coordinate credentialing activities related to new programs, services, locations, and revenue streams.

• Participate in audits, accreditation reviews, and compliance activities as required.

• Attend virtual and in-person internal and external training, conferences, and meetings as appropriate.

• Maintain compliance with HIPAA, mandated reporting requirements, and professional ethical guidelines.

• Travel within the designated service area.

• Perform other duties as assigned.

⛳️ Requirements

• A high school diploma or GED equivalent is required.

• A bachelor's degree in business, Public Health, Healthcare Administration, or a related field is preferred.

• Five years of experience in provider credentialing and payer enrollment in a healthcare setting is required.

• Three years of supervisory or management experience in a healthcare credentialing role is required.

• Experience with Ohio Medicaid provider enrollment and credentialing is necessary.

• Familiarity with credentialing systems and electronic health records is essential.

• Proficiency in utilizing NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals is required.

• Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance is necessary.

• Ability to independently manage multiple projects, deadlines, and priorities.

• Advanced analytical, organizational, and problem-solving skills are required.

• Proficiency with databases, spreadsheets, and Microsoft Office applications is expected.

• Strong oral and written communication skills are required.

• Advanced organizational skills are necessary.

• Knowledge of local, state, and federal regulations is essential.

• The ability to maintain confidentiality is required.

• Ability to adhere to all safety rules, regulations, and requirements.

• A valid driver's license and the ability to operate a motor vehicle are necessary.

• An appropriate level of auto insurance coverage is required.

• Ability to meet deadlines in a fast-paced, high-volume environment is essential.

• The ability to operate in an Internet-based, automated office environment is required.

• The ability to maintain a high-speed internet connection is necessary.

🏝️ Benefits

• Medical

• Dental

• Vision

• Short-term Disability

• Long-term Disability

• 401K with Employer Match

• Employee Assistance Program (EAP) provides support and resources to help you and your family with a range of issues.