Manager, Credentialing

Aspirion•Las Vegas, NV

About The Position

The Manager, Credentialing provides strategic and operational leadership for the credentialing function, ensuring providers are accurately and efficiently credentialed and recredentialed in accordance with payer, regulatory, client, and organizational requirements. This role leads and develops credentialing team members, oversees daily workflows and performance, manages escalated credentialing issues, and partners with internal and external stakeholders to ensure timely completion of credentialing activities. The Manager, Credentialing plays a critical role in maintaining provider participation, supporting revenue cycle operations, reducing credentialing-related delays, and ensuring compliance with applicable standards and requirements.

Requirements

High school diploma or equivalent required.
Minimum three years of credentialing, provider enrollment, healthcare operations, or related experience.
Minimum two years of supervisory or management experience preferred.
Strong knowledge of provider credentialing, recredentialing, payer enrollment, and provider data management processes.
Working knowledge of healthcare payer requirements and credentialing standards.
Experience managing team performance and operational metrics.
Strong analytical and problem-solving skills with the ability to identify trends and develop effective solutions.
Excellent written, verbal, and interpersonal communication skills.
Demonstrated ability to coach, mentor, and develop team members.
Strong organizational and time management skills with the ability to manage multiple priorities and deadlines.
Proficiency in Microsoft Office Suite, including Excel, Outlook, Word, Teams, and PowerPoint.
Ability to work effectively in a fast-paced, deadline-driven environment.

Nice To Haves

Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, or a related field.
Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification.
Experience with CAQH, PECOS, NPPES, state licensing systems, and payer enrollment portals.
Experience with credentialing software or provider data management systems.
Knowledge of NCQA, CMS, Medicare, Medicaid, and commercial payer credentialing requirements.
Experience managing credentialing for multiple clients, health systems, or provider groups.
Experience leading process improvement and workflow optimization initiatives.
Experience managing remote or hybrid teams.
Demonstrated success improving credentialing turnaround times, quality, and operational efficiency.
Experience developing reports and analyzing credentialing performance metrics.

Responsibilities

Demonstrate and promote Aspirion's mission, vision, and core values in all interactions.
Provide leadership, direction, coaching, and support to Credentialing Specialists and Lead Credentialing Specialists.
Oversee daily credentialing operations, including initial credentialing, recredentialing, payer enrollment, provider demographic updates, and maintenance of provider records.
Establish and monitor team performance expectations related to productivity, quality, accuracy, turnaround times, and service-level requirements.
Review operational reports and key performance indicators to identify trends, risks, and opportunities for improvement.
Ensure credentialing applications and documentation are complete, accurate, and submitted within required timelines.
Monitor provider credentialing and enrollment status and proactively identify potential delays or barriers.
Serve as an escalation point for complex credentialing issues, payer discrepancies, and provider enrollment concerns.
Research and resolve credentialing issues by partnering with payers, providers, clients, and internal departments.
Ensure all provider information and credentialing documentation is maintained accurately and securely.
Oversee the verification of provider credentials, including licenses, certifications, education, training, work history, sanctions, exclusions, malpractice coverage, and other required information.
Ensure credentialing activities are completed in accordance with payer requirements, regulatory standards, client expectations, and company policies.
Partner with internal teams, including Operations, Client Success, Revenue Integrity, Quality, Compliance, and The People Team, to resolve credentialing-related issues.
Develop and implement process improvements that increase efficiency, reduce errors, and improve credentialing turnaround times.
Identify opportunities for automation, standardization, and workflow optimization.
Lead and support the implementation of new credentialing processes, payer requirements, systems, and client initiatives.
Conduct regular one-on-one meetings, team meetings, coaching sessions, and performance reviews.
Support recruitment, onboarding, training, and development of credentialing teammates.
Identify opportunities to develop Lead Credentialing Specialists and other high-performing teammates for future leadership roles.
Partner with The People Team on employee relations matters, performance management, corrective actions, and other employment-related concerns.
Maintain strong relationships with internal and external stakeholders and provide timely communication regarding credentialing status and escalations.
Prepare and present operational reports and performance updates to senior leadership as needed.
Maintain current knowledge of credentialing regulations, payer requirements, healthcare industry standards, and applicable regulatory changes.
Ensure compliance with HIPAA, NCQA standards, payer requirements, company policies, and all applicable federal and state regulations.
Participate in special projects and perform additional duties as assigned.

Benefits

Demonstrate integrity, professionalism, and accountability in every interaction.
Lead by example while promoting Aspirion's mission, vision, and core values.
Foster a culture of accuracy, accountability, collaboration, and continuous improvement.
Maintain compliance with HIPAA, NCQA standards, payer requirements, company policies, and all applicable federal and state regulations.
Protect confidential provider, patient, client, and company information.
Promote consistent adherence to credentialing policies, procedures, and regulatory requirements.
Invest in teammate development through coaching, mentoring, and ongoing education.
Champion process improvement and operational excellence.
Build strong partnerships with internal teams, providers, clients, and external payer organizations.
Ensure credentialing activities are completed accurately, timely, and in accordance with established standards.