Credentialing Manager

Description

We are seeking an experienced and strategic Credentialing Manager to lead and manage client relationships in regards to credentialing/provider enrollment. Reporting to the Director of Provider Relations, this role will be responsible for owning the client success roadmap, driving operational excellence across credentialing and enrollment workflows, and serving as a senior liaison between providers, payers, and internal stakeholders.

The Credentialing Manager will work closely with client stakeholders to own customer communication, establish best practices, ensure compliance, and drive continuous improvement aligned with organizational growth. This role blends account management, process ownership, and strategic execution in a fast-paced healthcare services environment.

What You Will Do

Client Relationship Management

• Serve as main point of contact for assigned clients, addressing inquiries and concerns proactively.
• Conduct regular client meetings to review provider enrollment and credentialing data, discuss challenges, and align on goals.
• Monitor and analyze key performance indicators (KPIs) such as retention/turnover rate, credentialing turnaround time, Network Adequacy, Net Promoter Score, etc.

Operational Oversight

• Oversee all provider enrollment, credentialing, and re-credentialing activities to ensure accuracy, timeliness, and payer compliance.
• Ensure effective tracking, reporting, and documentation of enrollment status, payer communications, and provider data across systems.
• Act as the primary point of contact for complex provider, payer, or claims-related issues.
• Knowledge of CAQH profiles, payer applications, and internal databases

Process Improvement & Strategy

• Identify and implement process improvements to streamline workflows, reduce cycle times, and improve provider experience.
• Standardize SOPs, reporting structures, and quality controls across the Provider Relations function.
• Analyze trends, bottlenecks, and performance metrics to inform decision-making and continuous improvement initiatives.
• Support departmental strategy and scaling efforts as the organization grows nationally.

Stakeholder Management

• Serve as a key liaison with internal teams including Revenue Cycle, Operations, Compliance, and Clinical Leadership.
• Provide executive-level updates and reporting to leadership on provider enrollment status, risks, and capacity planning.
• Ensure clear, professional communication with providers and external partners.

What It Takes to Join the Team

• 5+ years of experience in provider relations, credentialing, enrollment, or healthcare operations.
• 2+ years of people management experience, including managing Team Leads or supervisors.
• 2+ years of account management or customer success experience, serving as primary point of contact for clients.
• Strong understanding of medical billing, payer enrollment, claims resolution, and healthcare workflows.
• Proven ability to lead teams, drive accountability, and implement scalable processes.
• Bachelor’s degree required; degree in healthcare administration, business, or process improvement preferred.
• Exceptional organizational, analytical, and reporting skills.
• Strong communication skills with the ability to influence across levels and functions.
• Proficiency in Microsoft Office Suite and credentialing/enrollment databases.
• Ability to thrive in a fast-paced, high-growth environment with evolving priorities.
• Detail-oriented with strong problem-solving and decision-making capabilities.