Credentialing Manager
About The Position
At Infusion for Health, we are dedicated to providing exceptional care to our patients! We believe in delivering high-quality healthcare services with compassion and empathy. As we continue to grow, we are seeking a dynamic and experienced Credentialing Manager to join our team. This is a newly created role designed to help us continue to grow and scale our organization and credentialing efforts. The Credentialing Manager oversees all aspects of provider and organizational credentialing, recredentialing, privileging, and payer enrollment. This includes ensuring compliance with CMS, The Joint Commission (TJC), NCQA, URAC, and state/federal regulations while maintaining accurate provider and facility credentialing records. The role also leads credentialing for new site/location expansion, ensuring timely payer enrollment to support revenue cycle operations.
Requirements
- Bachelor’s degree in Healthcare Administration, Business, or related field required (Master’s preferred) or equivalent experience.
- Minimum 5 years of provider/facility credentialing experience, with 2+ years leadership responsibility.
- Direct experience with new location/site credentialing and payer enrollment.
- Familiarity with credentialing software and payer systems (CAQH, PECOS).
Nice To Haves
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred.
Responsibilities
- Manage the end-to-end credentialing process for physicians, advanced practice providers, and allied health professionals.
- Oversee initial credentialing, recredentialing, and continuous monitoring of licensure, DEA registration, board certification, malpractice coverage, and sanction/exclusion lists.
- Ensure compliance with CMS, TJC, NCQA, URAC, and payer enrollment standards.
- Maintain credentialing database(s) and provider/facility files with accurate, real-time information.
- Lead credentialing and payer enrollment activities for new sites, clinics, and facilities.
- Coordinate with operations, finance, and revenue cycle teams to ensure new locations are properly registered with Medicare, Medicaid, and commercial payers, credentialed under organizational NPI and Tax ID as applicable, and fully operational for billing and reimbursement by the go-live date.
- Serve as liaison with payers to resolve credentialing or site enrollment delays that impact reimbursement.
- Supervise credentialing staff, providing training, guidance, and performance management.
- Develop, implement, and update credentialing policies, workflows, and SOPs.
- Act as a resource for medical staff, operations, and compliance leadership.
- Monitor regulatory and payer requirements; implement changes to maintain compliance.
- Conduct internal audits of credentialing and enrollment files, ensuring accuracy and timeliness.
- Partner with Compliance and Legal to mitigate risk related to provider or facility credentialing.
- Oversee and track payer enrollment for providers and locations to minimize claim denials and payment delays.
- Manage payer portal access, create and manage user logins, setup administration.
- Collaborate with billing and contracting to maintain alignment between payer rosters and credentialing data.
- Ensure timely updates to CAQH, PECOS, and payer portals.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
