Job Description
About the Role
We are a growing behavioral health practice operating across 9 states with a team of over 500 licensed clinicians. As we continue to expand, we are seeking an experienced and detail-oriented Credentialing Manager to lead our provider and payor credentialing operations. This is a high-impact remote based leadership role responsible for ensuring all clinicians are properly credentialed and enrolled with government and commercial payers in a timely, compliant, and accurate manner.
Key Responsibilities
- Team Leadership & Operations
- Supervise, mentor, and manage the credentialing team, including coordinators and specialists
- Establish and optimize credentialing workflows to support onboarding of new clinicians across all 9 states
- Monitor team performance, set KPIs, and conduct regular audits to ensure accuracy and timeliness
- Serve as the primary escalation point for credentialing issues, denials, and delays
- Provider Credentialing
- Oversee initial credentialing, re-credentialing, and privileging for 500+ licensed behavioral health clinicians
- Ensure all provider files are complete, compliant, and up to date across all applicable state and payer requirements
- Manage CAQH ProView profiles for all providers, including regular attestation and data accuracy
- Coordinate with HR and clinical leadership to support new provider onboarding timelines
- Payor Enrollment & Government Programs
- Lead enrollment and re-enrollment processes with Medicare and Medicaid programs across all 9 operating states
- Manage relationships with government and commercial payer enrollment departments
- Ensure compliance with CMS enrollment requirements, including PECOS management for Medicare providers
- Track and resolve enrollment applications, follow up on pending applications, and resolve rejections promptly
- Stay current on payer policy changes, fee schedule updates, and enrollment requirements
- NCQA & Compliance
- Ensure credentialing processes align with NCQA standards and support accreditation and re-accreditation efforts
- Maintain policies and procedures for the credentialing program in accordance with NCQA, state regulations, and organizational requirements
- Prepare for and participate in NCQA audits and surveys
- Ensure timely primary source verification for all applicable credentials
- Reporting & Systems
- Maintain accurate credentialing data and reporting dashboards; provide regular status updates to leadership
- Identify and flag providers with expiring credentials, lapsed enrollments, or red-status issues requiring immediate attention
- Partner with billing and revenue cycle teams to minimize claim denials related to credentialing gaps
Qualifications
- Required
- Minimum 5 years of experience in provider and/or payor credentialing, with at least 2 years in a supervisory or management role
- Demonstrated experience with Medicare and Medicaid credentialing and enrollment, including multi-state Medicaid programs
- Proficiency with CAQH ProView, including provider profile management and attestation processes
- Working knowledge of NCQA credentialing standards
- Strong understanding of primary source verification, credentialing workflows, and payer enrollment processes
- Experience managing credentialing for large provider groups (100+ clinicians preferred)
- Exceptional organizational skills with the ability to manage multiple priorities across jurisdictions
- Preferred
- Experience in behavioral health or mental health settings
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM) designation
- Familiarity with state-specific Medicaid and Medicaid managed care organizations (MCOs)
- Experience with credentialing software platforms
- Knowledge of telehealth credentialing requirements across multiple states
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