Credentialing Manager

• Position Type: Full Time

BetterHealth A Planned Parenthood Partnership

Job Description

Job Title: Credentialing & Licensing Services Manager

Location: Remote

Department: Revenue Cycle Management

Reports to: Vice President of Revenue Cycle

Employment Type: Full time, Exempt

Travel Required: Yes

Salary Range: $77,800- $81,400

Summary

The Credentialing & Licensing Services Manager provides strategic and operational leadership for the organization’s credentialing, licensing, privileging, recredentialing, and payer enrollment programs. This role is accountable for ensuring all credentialing operations meet NCQA standards, federal and state regulatory requirements, payer specific guidelines, and internal quality benchmarks.

The Manager oversees the end to end credentialing lifecycle, including primary source verification, file completeness, documentation integrity, delegation oversight, and audit preparedness. This position is responsible for building scalable processes, implementing credentialing technology solutions, optimizing workflows, and ensuring timely, accurate enrollment of practitioners across all contracted payers.

As a key organizational leader, the Manager supervises credentialing staff, drives performance and quality outcomes, and fosters a culture of accountability, service excellence, and continuous improvement. The role collaborates closely with executive leadership, compliance, legal, revenue cycle, operations, and client-facing teams to ensure credentialing operations support organizational growth and enhance client experience.

The Manager serves as the primary liaison between senior leadership, clients, and credentialing teams ensuring transparent communication, issue resolution, and alignment on credentialing requirements, timelines, and service expectations. This position also contributes to new service development, assists with proposals and client onboarding, and supports strategic initiatives that expand the organization’s credentialing and licensing portfolio.

Essential Functions

• Provide strategic oversight of credentialing, licensing, recredentialing, privileging, and payer enrollment operations.
• Establish departmental standards, policies, and performance metrics.
• Ensure compliance with federal, state, payer, and accreditation requirements.
• Regulatory & Audit Oversight
  • Serve as the escalation point for complex cases, audits, and payer or regulatory inquiries.
  • Monitor regulatory changes and update policies and processes accordingly.
  • Oversee internal audits and external payer or regulatory reviews.
• People Leadership & Team Development
  • Directly supervise credentialing and licensing staff, including hiring, training, coaching, and performance management.
  • Build scalable staffing models aligned with client growth and service demand.
  • Conduct regular performance reviews and professional development planning.
  • Foster a culture of accountability, quality, and continuous improvement.
• Assist the Associate Director of Quality Assurance with development of SOPs, training materials, and quality assurance frameworks related to credentialing and payer enrollment.
• Lead implementation and optimization of credentialing technology platforms and automation.
• Establish audit ready systems for documentation, tracking, and compliance reporting.
• Ensure consistent primary source verification and documentation standards.
• Partner with executive leadership to develop, price, and position credentialing and licensing services.
• Contribute to marketing materials, proposals, and client presentations.
• Support client discovery calls, solution design, and contract development.
• Identify new market opportunities and service line expansion.
• Collaborate with revenue cycle, compliance, legal, and operations teams to align services and workflows.
• Act as a subject matter expert in credentialing and licensing best practices.
• Partner with revenue cycle leadership to align credentialing with billing, appeals, eligibility, and denial management processes.
• Provide executive level oversight of credentialing related impacts to revenue performance.
• Ensure credentialing processes align with NCQA requirements

Supervisory Responsibility: Yes, demonstrates a commitment to supervisory responsibilities, fostering team development and ensuring effective operations.

Competencies:

To perform the job successfully, an individual should demonstrate the following competencies:

• Business Acumen, Strategic Thinking, Problem Solving,
• Customer Service and Interpersonal Skills, Oral and Written Communications
• Ethics, Diversity, Initiative, Teamwork, Leadership
• Computer and Technical Skills
• Experience with quality management frameworks.
• Demonstrated experience building, managing, and leading operational teams.
• Expert knowledge of Medicare, Medicaid, managed care, and commercial payer requirements.

Education and/or Experience

• Bachelor’s degree in healthcare administration, Business, or a related field (or equivalent experience).
• 5 to 8+ years of experience in provider credentialing, licensing, and payer enrollment.
• CPCS, CPMSM, or equivalent professional credentialing certification preferred.

Skills

Required

• Possesses excellent time management and organizational skills.
• Experience with credentialing and PSV technology platforms.
• Demonstrates a willingness to learn new software and systems.
• Conveys the ability to gain trust and establish effective relationships with peers and leadership.
• Seeks, logically examines, and interprets information from different sources to determine a problem’s cause and develops a course of action to resolve the problem and to prevent its recurrence.
• Demonstrated understanding of the role that racial inequity plays in our society and its impact on healthcare systems and institutions
• Strategic leadership and operational execution
• Team building and talent development
• Regulatory and payer compliance expertise
• Business and revenue growth mindset
• Process design, automation, and optimization
• Client relationship and service line development
• Data-driven operational decision-making

Preferred

• Experience with credentialing software systems and workflow automation.
• Experience supporting sales, marketing, and business development initiatives.
• Knowledge of NCQA credentialing standards preferred

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, talk, and listen. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus.

Sedentary Work

• Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time)
• And/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects.
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
• Must be able to travel throughout and between facilities.
• Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.
• There is no occupational risk for exposure to communicable diseases.