Senior Manager, Credentialing – Provider Data Management Systems

This is a fully remote position, open to applicants in Arizona, +7 more states.

📋 Description

• Supervise all direct processes related to credentialing and provider data entry, from initial triage to provider enrollment and ongoing data maintenance.

• Lead a team that supports the credentialing and provider data management organization from a technical standpoint.

• Oversee system updates, enhancements, data analysis, and reporting activities.

• Provide direct supervision for the credentialing and re-credentialing processes of physicians, mid-level practitioners, and organizational providers.

• Manage provider data management functions, including the development of training materials, policies, and procedures.

• Ensure that updates to provider records adhere to health plan policies as well as state and federal regulations.

• Maintain compliance with corporate KPIs, NCQA credentialing standards, and applicable state and federal requirements.

• Oversee the production and updates of both hard copy and online provider directories.

• Ensure the accuracy of provider enrollment specifications, including specialty types and demographic information.

⛳️ Requirements

• Must possess authorization to work in the U.S. without the need for employment-based visa sponsorship, both now and in the future.

• Bachelor’s degree or equivalent professional experience is required.

• A minimum of 4 years of relevant experience is necessary.

• Knowledge of NCQA standards, credentialing, and provider data management is essential.

• At least 3 years of supervisory or management experience is preferred.

• Preferred qualifications include a strong technical background.

• Experience in leading technical teams is preferred.

• Hands-on expertise with SQL Server is preferred.

• Knowledge of provider data management (PDM), credentialing, and managed care operations is preferred.

• Experience with Portico, Amisys, and CenProv is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plan.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentives may be included in the total compensation package.