Credentialing Manager

Responsibilities

• Maintain strict alignment with NCQA, URAC, Joint Commission, CMS, and state regulatory guidelines
• Design, implement, and audit internal quality control processes to ensure zero gaps in provider files
• Serve as the lead coordinator for all external facility and plan audits
• Manage relationships with major commercial insurance plans, Medicare, and Medicaid
• Monitor key performance indicators (KPIs) like Days to Enroll and resolve complex application rejections
• Collaborate with Compliance, Billing, Legal, Clinical and Revenue operations teams to troubleshoot claim denials
• Oversee the accuracy and security of the credentialing database
• Ensure CAQH profiles, NPPES data, and state license renewals are updated systematically
• Oversee the full lifecycle of state-level licensing, including medical boards, DEA, and facility-level DME licenses

Requirements

• Minimum o...