Credentialing Manager

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

📋 Description

• Ensure adherence to NCQA, URAC, Joint Commission, CMS, and state regulatory standards.

• Develop, implement, and assess internal quality control procedures to guarantee no gaps in provider documentation.

• Act as the primary coordinator for all external facility and plan audits.

• Cultivate and manage relationships with significant commercial insurance providers, Medicare, and Medicaid.

• Track key performance indicators (KPIs) such as "Days to Enroll" and proactively address complex application rejections to safeguard organizational cash flow.

• Work in close collaboration with the Compliance, Billing, Legal, Clinical, and Revenue operations teams to resolve credentialing-related claim denials.

• Supervise the accuracy and security of the credentialing database.

• Ensure that CAQH profiles, NPPES data, and state license renewals are consistently updated across the entire provider roster.

• Manage the complete lifecycle of state-level licensing, including oversight of individual provider credentials (state medical boards, DEA, and controlled substance certificates) as well as facility-level DME operating licenses, out-of-state distribution permits, and surety bond renewals across all active markets.

⛳️ Requirements

• A minimum of 6+ years in healthcare credentialing, including at least 1–2 years in a supervisory or lead specialist position.

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field is preferred (equivalent direct experience will be accepted).

• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) certification is mandatory.

• Proficiency in CAQH, PECOS, and standard credentialing software.

• Outstanding attention to administrative details, excellent verbal communication skills (for negotiating with insurance representatives), and proven capability to manage sensitive and confidential provider information.

🏝️ Benefits

• Medical, vision, and dental insurance.

• XX% of employee medical, vision, & dental premiums covered by the Company.

• Option to enroll in both a medical FSA and dependent care FSA.

• 401(k) plan with fully matching contributions up to 3% of salary and 50% matching from 3% to 5% of salary.

• Paid Time Off in accordance with the company’s policies.

• Commuter benefits for Seattle-based employees.