Provider Enrollment and Credentialing Manager

Role overview

Provider onboarding

• Collect and verify every document required for provider credentialing.
• Follow up persistently with providers when documents are late or incomplete.
• Maintain current provider document sets and track expiration dates to prevent lapses.

Payer enrollment and credentialing

• Manage initial enrollment, re-credentialing, and revalidation across Medicare, Medicaid, and commercial payers.
• Handle individual and group enrollment and link rendering providers to group entities.
• Diagnose enrollment failures and maintain CAQH profiles and master credentialing records.
• Track provider and payer effective dates and publish actionable status information.
• Support expansion into new payers and states.

Payer relationships and escalation

• Contact payers directly and persist until enrollment questions are resolved.
• Review and resolve payer contract issues, entity name mismatches, incorrect addresses, and effective-date discrepancies.
• Work with billing on credentialing-related denials and drive corrected claim resubmissions.

Systems and leadership

• Build and continuously improve the systems used to manage credentialing and enrollment.
• Create tracking that shows each provider's status with every payer and identifies process bottlenecks.
• Automate appropriate work, standardize manual processes, and document procedures.
• Supervise a credentialing specialist and provide scheduling with current provider-plan availability.
• Communicate enrollment status directly to providers, including when approvals are delayed.

Core qualities

• Persistence, organization, strong written communication, and willingness to own measurable enrollment outcomes are important for the role.
• The role requires comfort with repeated provider follow-up, process improvement, and learning detailed operational mechanics quickly.

Preferred experience

• Three or more years of provider enrollment and credentialing experience with hands-on Medicaid and Medicare experience is preferred.
• Knowledge of NPI structures, CAQH, PECOS, MCO delegation, revalidation cycles, effective dates, and retroactive billing windows is preferred.
• Supervisory experience, process automation experience, and healthcare administration, revenue cycle, or medical billing experience are preferred.

Pay and benefits

• The listed pay range is $50,000-$65,000 per year.
• Benefits include paid time off.

Work location

• The work location is in person.