Credentialing Manager

NaphCare•Birmingham, AL

2d•Onsite

About The Position

NaphCare is hiring a Credentialing Manager for its Corporate Headquarters in Birmingham, Alabama. This is not a remote position. The Credentialing Manager oversees the corporate credentialing team and manages provider credentialing and recredentialing, collaborative practice and supervisory agreements, credentialing communications, and peer review. The position is the primary liaison between the Credentialing Department and NaphCare corporate physicians and collaborates with Recruiting, Operations, and other internal stakeholders to support provider onboarding and ongoing compliance. The role ensures credentialing files, documentation, and processes comply with applicable federal and state regulations, accreditation standards, and client contractual requirements across the states where NaphCare operates. It maintains accurate and complete records, monitors compliance deadlines, supports audits and new contract implementations, and develops processes for efficient and consistent credentialing practices. The manager supervises three credentialing team members; oversees provider credentialing, recredentialing, agreements, communications, peer review, and expirables; and coordinates audit preparation, contract startups, reporting, policies, procedures, and process improvements. The role also provides credentialing information for proposals and client inquiries and performs other duties as assigned.

Requirements

Minimum of 5 years of provider credentialing experience.
Experience with multistate credentialing.
Knowledge of primary source verification, NPDB, OIG, and SAM queries, state licensure requirements, collaborative practice requirements, and NCCHC, ACA, and Joint Commission credentialing standards.
Strong written and verbal communication skills.
Attention to detail and strong organizational skills, including the ability to manage competing deadlines.
Proficiency in Microsoft Office and credentialing software.
Ability to handle confidential information with discretion.

Nice To Haves

Bachelor’s degree in healthcare administration, business, or a related field; equivalent experience may be considered.
At least 2 years in a lead or supervisory role.
Correctional healthcare experience.
Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification.

Responsibilities

Supervise three credentialing team members, assigning responsibilities, setting priorities, monitoring productivity and quality, and recruiting, hiring, training, coaching, and developing staff.
Conduct performance evaluations and annual reviews, provide ongoing feedback, and address performance concerns.
Oversee initial credentialing and recredentialing for physicians, nurse practitioners, physician assistants, dentists, and other licensed healthcare providers.
Ensure primary source verification, background and exclusion screenings, and supporting documentation are completed accurately and according to applicable requirements.
Monitor credentialing status and ensure provider files are completed, reviewed, and approved before scheduled start dates, as applicable.
Coordinate credentialing timelines with Recruiting and Operations, resolve documentation issues, and support timely provider onboarding.
Oversee the preparation, execution, tracking, maintenance, and renewal of collaborative practice and supervisory agreements.
Ensure agreements comply with state laws, regulatory requirements, and organizational policies; monitor relevant legal changes and coordinate updates.
Manage the credentialing department inbox, ensuring requests are assigned, prioritized, tracked, and addressed on time.
Ensure timely and professional responses to inquiries from providers, facility personnel, clients, external agencies, and internal stakeholders.
Identify, resolve, and escalate complex credentialing issues, delays, and compliance concerns.
Coordinate peer review, including reviewer assignments, scheduling, completion tracking, and communication of results to appropriate leadership.
Maintain peer review records and handle documentation according to confidentiality, organizational, legal, and regulatory requirements.
Serve as the primary credentialing contact for NaphCare corporate physicians and facilitate collaboration with the Credentialing Department.
Track and monitor expirations for licenses, DEA registrations, state controlled substance registrations, board certifications, life support certifications, malpractice coverage, and other required credentials.
Establish and monitor renewal processes, identify risks involving expired or incomplete credentials, and coordinate timely resolution.
Maintain credentialing files and processes in accordance with applicable regulations, NCCHC, ACA, Joint Commission, and client contractual requirements.
Ensure credentialing documentation is accurate, complete, organized, and available for reviews, audits, accreditation activities, and client requests.
Coordinate audit preparation and responses to documentation requests and address deficiencies through corrective actions.
Monitor changes to regulatory, accreditation, and contractual requirements and implement process updates.
Support credentialing activities for new contract awards, facility openings, and operational transitions; coordinate requirements and timelines to facilitate provider readiness.
Provide credentialing information and documentation for business proposals, client inquiries, and contract requirements.
Maintain the credentialing database and tracking systems, ensuring records are accurate, current, and complete.
Develop and maintain reports on credentialing status, file completion, turnaround times, upcoming expirations, and other key performance indicators.
Analyze credentialing data for trends, workflow challenges, compliance risks, and process improvement opportunities; provide reports to leadership.
Develop, maintain, review, and update credentialing policies, procedures, workflows, and related documentation.
Promote standardized credentialing practices across applicable states and facilities and improve operational efficiency, accuracy, accountability, and compliance.
Perform other duties as assigned.