About the Role
We are a growing behavioral health practice operating across 9 states with a team of over 500 licensed clinicians. As we continue to expand, we are seeking an experienced and detail-oriented Credentialing Manager to lead our provider and payor credentialing operations. This is a high-impact remote based leadership role responsible for ensuring all clinicians are properly credentialed and enrolled with government and commercial payers in a timely, compliant, and accurate manner.
Key Responsibilities
Team Leadership & Operations
• Supervise, mentor, and manage the credentialing team, including coordinators and specialists
• Establish and optimize credentialing workflows to support onboarding of new clinicians across all 9 states
• Monitor team performance, set KPIs, and conduct regular audits to ensure accuracy and timeliness
• Serve as the primary escalation point for credentialing issues, denials, and delays
Provider Credentialing
• Oversee initial credentialing, re-credentialing, and privileging for 500+ licensed behavioral health clinicians
• Ensure all provider files are complete, compliant, and up to date across all applicable state and payer requirements
• Manage CAQH ProView profiles for all providers, including regular attestation and data accuracy
• Coordinate with HR and clinical leadership to support new provider onboarding timelines
Payor Enrollment & Government Programs
• Lead enrollment and re-enrollment processes with Medicare and Medicaid programs across all 9 operating states
• Manage relationships with government and commercial payer enrollment departments
• Ensure compliance with CMS enrollment requirements, including PECOS management for Medicare providers
• Track and resolve enrollment applications, follow up on pending applications, and resolve rejections promptly
• Stay current on payer policy changes, fee schedule updates, and enrollment requirements
NCQA & Compliance
• Ensure credentialing processes align with NCQA standards and support accreditation and re-accreditation efforts
• Maintain policies and procedures for the credentialing program in accordance with NCQA, state regulations, and organizational requirements
• Prepare for and participate in NCQA audits and surveys
• Ensure timely primary source verification for all applicable credentials
Reporting & Systems
• Maintain accurate credentialing data and reporting dashboards; provide regular status updates to leadership
• Identify and flag providers with expiring credentials, lapsed enrollments, or red-status issues requiring immediate attention
• Partner with billing and revenue cycle teams to minimize claim denials related to credentialing gaps
Qualifications
Required
• Minimum 5 years of experience in provider and/or payor credentialing, with at least 2 years in a supervisory or management role
• Demonstrated experience with Medicare and Medicaid credentialing and enrollment, including multi-state Medicaid programs
• Proficiency with CAQH ProView, including provider profile management and attestation processes
• Working knowledge of NCQA credentialing standards
• Strong understanding of primary source verification, credentialing workflows, and payer enrollment processes
• Experience managing credentialing for large provider groups (100+ clinicians preferred)
• Exceptional organizational skills with the ability to manage multiple priorities across jurisdictions
Preferred
• Experience in behavioral health or mental health settings
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM) designation
• Familiarity with state-specific Medicaid and Medicaid managed care organizations (MCOs)
• Experience with credentialing software platforms
• Knowledge of telehealth credentialing requirements across multiple states