Credentialing Manager

Bridgeview Eye Partners•Wabash, IN

3d•Remote

About The Position

The Credentialing Manager is responsible for overseeing all aspects of payer enrollment, recredentialing, and ongoing maintenance of provider participation in insurance networks. This role ensures compliance with regulatory requirements and payer-specific standards, while streamlining credentialing processes to support rapid onboarding of new providers and locations across the organization. Wage will be determined based on knowledge, skills, and experience. This is a remote position.

Requirements

Bachelor’s degree or equivalent experience required
3-5 years of credentialing experience
2+ years in a supervisory role
Proficiency in Microsoft Office
Strong knowledge of CPT, ICD-10, and HCPCS codes relevant to optometry/ophthalmology
Knowledge of insurance guidelines relevant to optometry/ophthalmology
Attention to detail
Professional Integrity

Nice To Haves

Experience in optometry/ophthalmology or outpatient healthcare preferred
Experience in delegated credentialing and/or managed care contracting preferred
CPCS or CPMSM certification preferred

Responsibilities

Manage and execute the end-to-end credentialing life cycle (initial credentialing, recredentialing, and expiration tracking)
Oversee payer enrollment applications, PECOS updates, CAQH maintenance, NPPES records, and delegated agreements
Monitor and ensure compliance with NCQA, CMS and commercial payer standards
Maintain an accurate credentialing database
Lead, supervise, and support team of Provider Enrollment Specialists, ensuring timely submission and follow-up of applications
Establish, document, and refine credentialing workflows, SOPs, and KPIs
Act as primary liaison with insurance plans to resolve enrolment delays or issues
Stay current with payer policy updates and state/federal regulations
Support audits related to credentialing files
Provide weekly and monthly updates on credentialing status and turnaround times
Track and report on pending expirations to avoid lapses
Prepare credentialing rosters and enrollment summaries
Perform other duties as assigned
Be a champion of the company's overall culture and commitment to patient care.
Align strategic goals and resources to maximize profitability.
Collaborate across the organization to identify needs and develop scalable solutions.
Work on integration and post-acquisition teams as needed.
Drive operational excellence to achieve the organization’s financial goals.
Maintain compliance with the organization’s policies and applicable regulatory guidelines.
Build and lead creative, collaborative teams; develop people; and link performance to overall business objectives.
Guide and evaluate the work of other employees, including peers, to ensure a healthy working environment.
Proactively recruit, hire, train, motivate and retain current and future leaders.