Credentialing Manager/Director

Job Description

• Develop, implement, and enforce policies and procedures for credentialing and payer enrollment across all states and markets.
• Oversee the full lifecycle of credentialing and recredentialing for providers, ensuring accuracy, compliance, and timeliness.
• Lead, mentor, and manage credentialing and enrollment staff, including performance management, training, and team development.
• Ensure accurate, up-to-date provider data in internal systems and payer portals
• Monitor and maintain compliance with CMS, NCQA, URAC, federal/state regulations, and payer-specific requirements.
• Collaborate cross-functionally with finance, contracting, revenue cycle, legal, operations, and clinical leadership to support timely provider onboarding and billing readiness.
• Serve as the primary point of contact for escalated issues with payers, regulatory agencies, and partner practices.
• Maintain strong relationships with payer representatives and credentialing contacts.
• Provide regular status updates and reports to executive leadership, including key performance indicators (KPIs), risk areas, and opportunities for process improvement.

Qualifications

• Bachelor’s degree required in healthcare administration, business, or related field; Master’s degree preferred.
• Minimum 5 years of experience in non-delegated healthcare credentialing and payer enrollment, with at least 2 years in a leadership capacity.
• Deep understanding of credentialing standards, payer enrollment protocols, and federal/state regulatory requirements.
• Hands-on experience with PECOS, CAQH, NPPES, Availity, and other credentialing/enrollment platforms.
• Demonstrated ability to lead, coach, and develop high-performing teams in a fast-paced environment.
• Excellent communication, organizational, and problem-solving skills.
• Technically proficient with Microsoft Office and credentialing management systems (e.g., Verity, Medallion, Modio, or similar).
• Proven ability to manage confidential and sensitive information with discretion.