Credentialing Manager - Infusion Pharmacy

Amerita • Greenwood Village, CO

1d • $85,000 - $120,000 • Remote

About The Position

The Credentialing Manager leads and oversees enterprise-wide credentialing and recredentialing operations for pharmacies, ambulatory infusion suites, and nurse practitioner services across multiple states. This role ensures full compliance with federal, state, accreditation, and payor-specific credentialing requirements in a highly regulated healthcare environment, while supporting organizational growth and operational excellence

Requirements

• Bachelor’s Degree in healthcare administration, business, or a related field
• Minimum of five (5) years health care experience
• Extensive experience in healthcare credentialing, enrollment, or provider operations (home infusion, specialty pharmacy, or multi-state healthcare preferred).
• Proven leadership experience managing credentialing teams in a complex, payor-driven environment.
• Deep understanding of Medicare, Medicaid, and commercial payor credentialing and enrollment requirements.
• Strong analytical, organizational, and cross-functional communication skills.
• Demonstrated ability to lead in a fast-paced, highly regulated healthcare setting

Responsibilities

• Manages day-to-day credentialing workflows for providers and facilities, including onboarding, recredentialing, and change management
• Supervises, mentors, and develops credentialing specialists to ensure accuracy, timeliness, and consistency across all markets
• Serves as the subject matter expert on credentialing standards related to home infusion therapy, specialty pharmacy, and ambulatory services
• Maintains compliance with CMS, state Medicaid agencies, commercial payors, and accreditation bodies (e.g., ACHC, URAC, The Joint Commission, NABP)
• Partners with contracting, revenue cycle, compliance, legal, and clinical leadership to support new business, acquisitions, and market expansion
• Oversees credentialing for multi-state licensure, DEA registrations, NPI enrollment, and specialty pharmacy-specific requirements
• Monitors credentialing metrics, turnaround times, and payor performance; identify risks and implement process improvements
• Leads audits, corrective action plans, and payor inquiries related to credentialing and enrollment
• Ensures credentialing data integrity within credentialing systems, payor portals, and internal provider databases
• Develops, maintains, and updates credentialing policies, procedures, and internal controls
• Scales credentialing operations to support acquisitions, de novos, and rapid geographic expansion
• Standardizes credentialing practices across regions while adapting to state-specific regulatory nuances
• Drives automation, technology adoption, and workflow efficiencies to reduce cycle time, administrative burden, and revenue leakage
• Provides executive-level reporting on credentialing status, risks, capacity constraints, and operational readiness
• Acts as a strategic advisor on credentialing implications for new service lines, care models, and clinical programs

Benefits

• Medical, Dental & Vision Benefits plus, HSA & FSA Savings Accounts
• Supplemental Coverage – Accident, Critical Illness and Hospital Indemnity Insurance
• 401(k) Retirement Plan
• Company paid Life and AD&D Insurance, Short-Term and Long-Term Disability
• Employee Discounts
• Tuition Reimbursement
• Paid Time Off & Holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level