Credentialing Manager

Recovery Centers Of America • King of Prussia, PA

313d

About The Position

The Credentialing Manager is responsible for overseeing the credentialing and recredentialing processes for all providers and facilities within the organization. This role ensures compliance with state and federal regulations, payer requirements, and organizational policies. The Credentialing Manager will lead the credentialing team, develop and refine credentialing workflows, and maintain accurate records to support billing and operational efficiency. This position requires strong leadership, attention to detail, and expertise in credentialing processes within the healthcare industry, particularly in substance use disorder (SUD) treatment.

Requirements

• Bachelor's degree in Healthcare Administration, Business, or a related field.
• Minimum of 3-5 years of experience in credentialing, preferably in a healthcare or SUD setting.
• In-depth knowledge of credentialing processes, including CAQH, payer credentialing, and state/federal regulations.
• Strong understanding of SUD treatment and related credentialing requirements.
• Proficiency in credentialing software and databases (e.g., CAQH, Symplr, or similar).
• Excellent organizational skills and attention to detail.
• Strong leadership and team management abilities.
• Ability to handle multiple priorities and meet deadlines in a fast-paced environment.

Nice To Haves

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) credential.

Responsibilities

• Supervise and mentor the Credentialing Specialist(s) and other credentialing staff, ensuring high performance and adherence to deadlines.
• Develop, implement, and maintain credentialing policies, procedures, and workflows to ensure compliance with state, federal, and payer requirements.
• Conduct regular audits of credentialing processes to ensure accuracy and compliance.
• Provide training and support to staff on credentialing processes, software, and regulatory updates.
• Serve as the primary point of contact for credentialing-related inquiries from internal and external stakeholders.
• Oversee the credentialing and recredentialing of all providers, ensuring timely submission and approval of applications.
• Monitor and manage expiring certifications, licenses, and other required documents, ensuring compliance with state and federal regulations.
• Ensure all provider credentials are accurately entered and maintained in the credentialing database (e.g., CAQH, payer portals, and internal systems).
• Collaborate with HR, Compliance, and Contracts teams to align credentialing processes with organizational goals.
• Manage the preparation and submission of credentialing applications to third-party payers and regulatory bodies.
• Ensure compliance with NCQA, URAC, and other accrediting body standards, as applicable.
• Prepare and present detailed reports on credentialing status, including pending applications, expiring credentials, and audit results.
• Conduct roster reconciliations and ensure accuracy in provider directories.
• Support internal and external audits by providing necessary documentation and reports.
• Communicate credentialing status and updates to providers, payers, and internal stakeholders.
• Resolve credentialing-related issues with payers, providers, and regulatory agencies.
• Collaborate with the Compliance and HR teams to address any credentialing-related compliance concerns.

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Education Level: Bachelor's degree