Credentialing Manager | ABA
About The Position
As the leader of our Credentialing Department, you will supervise and manage daily operations, focusing on workflow distribution, prioritization, and employee development. You will actively monitor application statuses, processing timelines, and department work queues to quickly identify and resolve delays or barriers. In this capacity, you will serve as the primary escalation point for complex credentialing, enrollment, contracting, and payer-related issues. You will also drive team success through continuous training, performance management, and quality assurance initiatives. You will oversee all credentialing, recredentialing, enrollment, and provider maintenance activities to ensure strict compliance with payer, regulatory, and organizational requirements. A core part of this role involves ensuring that provider licenses, certifications, NPI records, and CAQH profiles remain perfectly current. To maintain operational visibility and data integrity, you will manage departmental databases and tracking tools while conducting regular audits of provider files. You will also be responsible for developing and maintaining the department's standard operating procedures (SOPs) and policies, all while upholding strict confidentiality regarding protected health information, employees, and company operations. Collaboration is essential in this role. You will build and maintain effective relationships with payer representatives and regulatory agencies, while partnering internally with Operations, Recruiting, HR, and Clinical Leadership to support seamless provider onboarding and location roster maintenance. As the organization grows, you will participate in strategic planning related to market expansion by supporting contract development initiatives, researching new funding sources, and staying highly informed on federal, state, and accreditation requirements. By tracking key department metrics, you will prepare reports for leadership and lead continuous process improvement initiatives to increase the department’s overall efficiency and scalability. You will also take on special projects and additional duties as assigned.
Requirements
- Bachelor's degree in Healthcare Administration, Business Administration, Healthcare Management, or a related field preferred; equivalent experience may be considered.
- 3–5 years of healthcare credentialing, provider enrollment, contracting, or related experience required.
- Experience with CAQH, NPPES, PECOS, payer portals, and credentialing databases.
- Strong organizational, analytical, problem-solving, and project management skills.
- Ability to manage multiple priorities, meet deadlines, and collaborate effectively across departments.
Nice To Haves
- Previous supervisory, lead, or management experience preferred.
- Multi-state credentialing and provider enrollment experience strongly preferred.
- Experience working with commercial insurance plans, Medicaid, Medicare, Tricare, and other funding sources preferred.
Responsibilities
- Supervise and manage daily operations of the Credentialing Department, focusing on workflow distribution, prioritization, and employee development.
- Monitor application statuses, processing timelines, and department work queues to identify and resolve delays or barriers.
- Serve as the primary escalation point for complex credentialing, enrollment, contracting, and payer-related issues.
- Drive team success through continuous training, performance management, and quality assurance initiatives.
- Oversee all credentialing, recredentialing, enrollment, and provider maintenance activities to ensure compliance with payer, regulatory, and organizational requirements.
- Ensure provider licenses, certifications, NPI records, and CAQH profiles remain current.
- Manage departmental databases and tracking tools to maintain operational visibility and data integrity.
- Conduct regular audits of provider files.
- Develop and maintain the department's standard operating procedures (SOPs) and policies.
- Uphold strict confidentiality regarding protected health information, employees, and company operations.
- Build and maintain effective relationships with payer representatives and regulatory agencies.
- Partner internally with Operations, Recruiting, HR, and Clinical Leadership to support seamless provider onboarding and location roster maintenance.
- Participate in strategic planning related to market expansion by supporting contract development initiatives, researching new funding sources, and staying informed on federal, state, and accreditation requirements.
- Track key department metrics and prepare reports for leadership.
- Lead continuous process improvement initiatives to increase the department’s overall efficiency and scalability.
- Take on special projects and additional duties as assigned.
Benefits
- Competitive pay
- Optional On-Demand paychecks through DailyPay
- 401K Plan with company match after 6 months of employment
- Paid Personal Time Off
- Paid Holidays
- Medical, Dental and Vision Insurance
- Performance and promotion raises
- Free Telehealth: Free 24/7 access to a doctor via telehealth for you and your dependents with no limits and no co-pays
- Free Telehealth Mental Health: Free access to a mental health counselor via telehealth for you and your dependents (over age 13) with no limits or co-pays
- Employee Assistance Program: Free access to some support services (financial, legal, counseling etc.)
- Fitness: Discounted monthly gym membership to 12,000 gym locations nationwide, as well as free access to workout videos
- Deals: Exclusive discounts and savings to 500+ companies and more!
- Travel: Discounts of travel essentials including hotels, rental cars, flights, excursions and more!
- Lab Testing Discounts: 10-80% off costs of routine lab work
- New Benefits RX: Discounts on prescription medications from 10-80% at 60,000+ locations nationwide
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What This Job Offers
Job Type
Full-time
Career Level
Manager
