Credentialing Manager

Minnesota Autism Center•Minnetonka, MN

1d•Remote

About The Position

The Credentialing Manager is the organization’s subject matter expert on credentialing, provider enrollment, and regulatory eligibility for employees and other providers delivering client services. The role leads the credentialing program to ensure providers and applicable service locations meet Minnesota Department of Human Services (DHS), Early Intensive Developmental and Behavioral Intervention (EIDBI), and other applicable state, federal, and payer requirements. It ensures required qualifications, licensure, certifications, verifications, and enrollment approvals are completed and documented before providers deliver or bill for services that require them, and oversees ongoing monitoring to maintain provider eligibility and prevent lapses. The manager leads credentialing across provider types, service lines, and locations; develops policies, standard operating procedures, and workflows; anticipates credentialing needs; monitors program performance; and translates regulatory and payer changes into procedures, guidance, and training. The position supervises and develops credentialing staff, manages workloads and deadlines, and fosters consistent practices and timely escalation. The role oversees Minnesota DHS and EIDBI compliance, primary source verification, provider files, renewals and screenings, as well as commercial payer enrollment and recredentialing. It maintains accurate records and reporting, prepares for audits, and collaborates with internal departments, providers, payers, and regulatory agencies to align onboarding, provider readiness, and billing requirements. This is a full-time, exempt, remote position requiring the employee to live in Minnesota and attend onsite meetings as needed. Travel is limited. Salary is $75,000–$85,000.

Requirements

Associate degree in healthcare administration, business, or a related field, or an equivalent combination of education and relevant experience.
Experience in behavioral health or autism services.
At least five years of experience in healthcare credentialing, provider enrollment, regulatory compliance, or provider eligibility management.
Experience with Minnesota DHS programs or comparable state healthcare regulatory frameworks, including provider enrollment and eligibility requirements.
Experience with Medicaid and commercial payer enrollment, recredentialing, provider affiliations, and ongoing provider data maintenance.
Experience leading a team or managing credentialing operations, including assigning workloads, coaching staff, and maintaining accountability.
Demonstrated ability to develop and improve credentialing workflows, document procedures, and implement consistent practices.
Strong knowledge of primary source verification, provider file management, and ongoing compliance monitoring.
Strong attention to detail, organizational and problem-solving skills, and follow-through on competing deadlines.
Clear communication and a collaborative approach to working with providers, payers, regulatory agencies, and internal teams.
Experience using credentialing systems, payer portals, and reporting tools to maintain accurate data, monitor performance, and communicate progress.
Must live in Minnesota.

Nice To Haves

Experience with EIDBI requirements, MN–ITS, and Minnesota provider enrollment systems.
Certified Provider Credentialing Specialist (CPCS) certification.

Responsibilities

Lead credentialing across provider types, service lines, and locations to ensure compliance with regulatory and payer requirements.
Develop and implement policies, standard operating procedures, and workflows defining responsibilities, timelines, escalation procedures, and provider readiness checks.
Anticipate credentialing needs related to hiring, provider level changes, new services, and location changes.
Monitor program performance and lead improvements to prevent credentialing lapses and avoidable service or reimbursement delays.
Translate regulatory and payer changes into updated procedures, practical guidance, and staff training.
Supervise, coach, and develop credentialing staff, setting expectations for accuracy, timeliness, communication, and follow-through.
Prioritize workloads, monitor deadlines and backlogs, and establish cross-training and backup coverage.
Provide regular feedback, address performance concerns, and reinforce consistent practices.
Foster collaboration, shared visibility, and timely escalation of questions, barriers, and risks.
Confirm providers meet applicable qualification, enrollment, affiliation, and supervision requirements before delivering services that require those approvals.
Oversee DHS enrollment, affiliations, provider level changes, revalidation, and updates; verify approval status and effective dates.
Maintain accurate provider and location information in DHS systems, monitor agency communications, and resolve discrepancies.
Coordinate applicable service-location enrollment and licensing requirements with Compliance and Operations.
Oversee primary source verification of provider licensure, education, certifications, and other required qualifications.
Maintain complete provider files, including applicable experience and supervision documentation.
Monitor renewals, required screenings, sanctions, and ongoing provider eligibility.
Oversee payer applications, recredentialing, affiliations, and provider and location updates.
Track submissions, follow up with payers, and partner with Revenue Cycle to resolve discrepancies and escalate delays affecting services or reimbursement.
Maintain accurate credentialing records documenting ownership, provider readiness, deadlines, renewals, and approvals.
Use reports and dashboards to communicate progress, identify risks, prioritize work, and improve performance.
Review credentialing files, prepare for payer and regulatory audits, and coordinate resolution of documentation gaps and compliance concerns.
Partner across departments to align onboarding, provider readiness, and billing requirements while maintaining shared visibility.