Credentialing Manager
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Job Description
Credentialing Manager overseeing provider onboarding, credentialing, and payer enrollment for Managed Service Organization. Leading a team while ensuring compliance, operational accuracy, and service excellence.
Responsibilities:
- The Credentialing Manager leads the end to end credentialing, privileging, and payer enrollment function for the Managed Service Organization.
- Ensure timely, compliant provider onboarding while maintaining high standards of operational accuracy, audit readiness, and service excellence.
- Oversee full lifecycle credentialing, re-credentialing, privileging, and payer enrollment for all providers.
- Manage complex, escalated, or high priority credentialing cases.
- Support compliance and audit readiness practices, maintaining audit ready provider files and documentation standards.
- Provide day to day leadership, coaching, and workload management for credentialing specialists.
- Develop team capabilities through training and process documentation.
- Monitor turnaround times, application status, and enrollment effective dates.
- Partner with cross-functional teams for seamless provider onboarding and resolve credentialing related denials or reimbursement delays.
Requirements:
- Bachelor’s degree preferred; relevant experience may substitute
- CPCS certification strongly preferred
- Minimum three years of credentialing experience including payer enrollment and privileging
- Prior supervisory or team lead experience required
- Strong knowledge of NCQA, CMS, and payer credentialing standards
- Proficiency with Google Suite, Excel or Sheets, credentialing databases, and workflow tools
- Exceptional organizational skills and attention to detail
- Ability to manage multiple deadlines in a high volume environment
- Strong judgment, problem solving ability, and professional communication skills
- Ability to lead with accountability while maintaining strong provider relationships.
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