Credentialing Manager

Coronis Health • Delray Beach, FL

16h • $60,000 - $70,000

About The Position

The Credentialing Manager is responsible for overseeing provider and facility credentialing and payer enrollment activities to ensure timely submissions, consistent follow-up, and accurate documentation through completion. This role leads and supports Provider Enrollment & Privileging Specialists, maintains records within credentialing systems and tracking tools, partners cross-functionally with Billing and Collections to resolve credentialing-related claim issues, and delivers routine reporting and trend insights to leadership.

Requirements

• Self-motivated and detail-oriented with a strong operational and deadline-driven mindset.
• Strong knowledge of provider/facility credentialing, enrollment workflows, re-credentialing, and expirable document management.
• Results-oriented withabilityto implement and manage cross-functional initiatives.
• Proficient with credentialing systems and able to learn new tools/processes quickly.
• Effective communicator with strong written, verbal, and stakeholder-management skills (including physician offices and facility contacts).
• Strong organizational and prioritization skills; able to manage multiple workflows and competing deadlines.
• Sound judgmentregardingwhen to act independently and when to escalate or seek guidance.
• Demonstrates flexibility, professionalism, and customer focus.
• 3–4 years of credentialing experience (or equivalent related experience).
• Experience working with online payer portals and payer resources.
• Working knowledge of billing andcollectionsworkflows; accounts receivable experience is a plus.
• Proficiencyin Microsoft Office (Excel, Outlook, Word); ability tomaintaintracking logs and reporting.
• Excellent interpersonal skills and ability to work effectively in a team environment.

Nice To Haves

• Familiarity with facilitycredentialing and licensingconsiderations across multiple states.
• Experience supporting credentialing forphysician services, radiology, urology, hospitalist,behavioralhealthand/or multi-facility organizations (if applicable to your environment).

Responsibilities

• Directly oversees onshoreProvider & PrivilegingSpecialists, including daily workflow management, performance support, and accountability to deadlines and quality standards.
• Provides training, coaching, and ongoing process guidance to credentialing team members; supports onboarding and skill development.
• Monitors team adherence to documentation and file maintenance standards, including management of expirable documents and renewals/re-credentialing.
• Reviews department policies and procedures and recommends updates based on trends, payer changes, and operational needs.
• Oversees Medicare, Medicaid, and Commercial payer credentialing procedures for all assigned accounts.
• Manages provider enrollment and credentialing processes end-to-end, ensuring all facilities/providers are appropriately credentialed with required payers.
• Completes andsubmitsin-network participation requests and applications for facilities and/or providers as applicable.
• Performs ongoing follow-up on pending enrollments and escalates issues appropriately;assistsSpecialists with follow-up phone calls when needed.
• Conducts research todeterminecredentialing requirements prior to onboarding, including payer prerequisites and facility readiness.
• Partnerswith Client Success Management, andOperationsleadership to improve process accuracy, reduce credentialing-related billing delays, and meet performance goals.
• Acts as liaison with payers related to credentialing issues that impact claims (e.g., participation status discrepancies, effective dates, missing enrollments).
• Supports facility payer contracting coordination where applicable, ensuring alignment between payer participation status and operational workflows.
• Maintainsaccurateandtimelydocumentation in credentialing systems,Modio,SmartsheetandSalesforceand tracking tools/spreadsheets.
• Ensures facility and provider records are current, including licenses, contact information, documentation, and credentialing status.
• Ensures compliance with HIPAA and company policies and procedures.
• Completes monthly OIG/SAM monitoring and documentation (or ensures completion/validation by the team).
• Ensures credentialing documentation protocols are followed consistently across accounts and team members.
• Providesmonthlycredentialinginvoicingreporting toFinance.
• Provides regular updates on client health for Credentialing to Management team,including status updates, risks, barriers, and trends.
• Maintains ongoing weekly/monthly credentialing activity reporting (e.g., Credentialing Matrix).
• Identifiestrends and recurring barriers in credentialing activity, communicates impacts, and recommends solutions.
• Executes special projects and otherduties asassigned.
• Participates in companywide and departmental meetings.
• Delivers excellent customer service whilemaintainingprofessionalism in a team-based environment.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: No Education Listed