Senior Manager, Contracting & Credentialing
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Job Description
Senior Manager overseeing provider credentialing and payer contracting for telehealth sleep medicine organization. Requires extensive multi-state credentialing expertise and compliance understanding.
Responsibilities:
- Lead end-to-end provider credentialing, provider licensing and recredentialing for MDs and NPs across multiple states
- Oversee CAQH, PECOS, Medicare, and commercial payer enrollment
- Ensure compliance with state licensure, scope of practice, and supervision requirements
- Maintain credentialing records, expiration tracking, and audit-ready documentation
- Manage credentialing/licensing timelines to support rapid provider onboarding
- Lead payer contracting strategy across commercial, Medicare Advantage, and government payers
- Negotiate and evaluate fee schedules, reimbursement rates, and contract terms
- Oversee Medicare enrollment and compliance
- Collaborate with Compliance to mitigate credentialing and contracting risk
- Manage relationships with credentialing and contracting vendors
- Provide reporting and dashboards on credentialing status, payer growth, and risk areas
Requirements:
- CPC Certification (required)
- 7+ years of experience in provider credentialing, payer contracting, or provider enrollment
- Proven experience with multi-state credentialing and telehealth operations
- Strong knowledge of Medicare/PECOS, commercial payers, and government programs
- Experience managing third-party credentialing and contracting vendors
- Familiarity with sleep medicine, DME, or specialty care preferred
- Strong understanding of provider reimbursement and fee schedules
- Exceptional organizational, communication, and stakeholder-management skills
Benefits:
- Comprehensive health benefits (medical, dental, vision)
- FREE One Medical membership
- 401(k) with company match
- 20 days PTO + 10 paid holidays + 80 hours paid sick leave
- Monthly phone and internet stipend
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