Credentialing Manager – PCP & Ancillary Providers

Position SummaryThe Credentialing Lead is a senior healthcare operations leader responsible for provider credentialing, recredentialing, and payer enrollment across a growing medical organization.This role owns the end-to-end credentialing lifecycle for physicians and advanced practice providers (APPs) and ensures compliance with NCQA, CMS, state licensing boards, and payer requirements.This position focuses on process improvement, compliance, audit readiness, and scalability, ensuring credentialing and enrollment operations support organizational growth without delays or regulatory risk.This role is eligible for a performance-based bonus incentive.Key ResponsibilitiesProvider Credentialing & EnrollmentOwn the full provider credentialing and recredentialing process for physicians, APPs, and clinical staffManage payer enrollment with commercial, Medicare, and Medicaid plansServe as the credentialing subject-matter expert for regulatory and accreditation requirementsMaintain credentialing policies, procedures, and documentation standardsCredentialing Operations & Process ImprovementEvaluate and improve credentialing workflows, cycle times, and handoffsStandardize credentialing and enrollment processes to support multi-state growthDevelop SLAs, checklists, escalation paths, and quality controlsPartner with HR, Medical Operations, Revenue Cycle, Compliance, Legal, and ContractingCompliance, Risk Management & AuditsEnsure compliance with NCQA, CMS, state medical boards, and payer credentialing requirementsMaintain audit-ready credentialing files and lead internal and external auditsIdentify credentialing and enrollment risks and implement mitigation plansOversee clinician supervisory roster managementTeam Leadership & Credentialing ManagementLead, train, and develop credentialing and enrollment staffEstablish performance metrics and accountabilityCreate documentation and training to reduce operational riskScale credentialing team structure and workflows (Director level)Reporting & Stakeholder CommunicationTrack and report on credentialing KPIs (time to credential, time to enroll, backlog, expirables)Provide clear status updates to executive and clinical leadershipSet realistic credentialing and enrollment timelines with stakeholdersMinimum Qualifications5+ years of experience in provider credentialing and payer enrollmentAssociate’s degree required; Bachelor’s degree in Healthcare Administration, Business, or related field preferredProven experience managing provider credentialing operations in a healthcare or medical group settingStrong knowledge of NCQA, CMS, payer enrollment, and state licensing requirementsExperience leading credentialing teams and improving operational performanceStrong skills in process design, workflow optimization, and compliance managementPreferred QualificationsCPCS, CPMSM, or equivalent credentialing certificationExperience in healthcare services, medical groups, MSOs, or value-based care organizationsExperience supporting multi-state provider operationsExperience implementing or optimizing credentialing software or enrollment platforms Pay Range for Posted Region: $105,000 USD - $140,000 USD