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Credentialing Manager
BetterHealth. Provide strategic oversight of credentialing, licensing, recredentialing, privileging, and payer enrollment operations .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider credentialing, licensing, and payer enrollment, with a strong focus on compliance, operational leadership, and strategic oversight. Proficient in developing policies, performance metrics, and quality assurance frameworks to enhance credentialing processes.
Highest-signal resume keywords
Provider CredentialingPayer EnrollmentMedicare RequirementsCredentialing Technology PlatformsCPCS Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Credentialing OperationsLicensing ManagementPerformance Metrics DevelopmentQuality Management FrameworksPrimary Source VerificationAudit CompliancePolicy DevelopmentStaff SupervisionMarket Opportunity IdentificationDocumentation Standards
Soft Skills
Time ManagementOrganizational SkillsCoachingCollaborationLeadership
Tools & Technologies
Credentialing Technology PlatformsQuality Assurance Frameworks
Certifications & Qualifications
CPCS CertificationCPMSM Certification
Industry Keywords
Healthcare AdministrationNCQA StandardsManaged CareCommercial Payer RequirementsRegulatory Compliance
About the role
Key responsibilities & impact- 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
- Serve as escalation point for complex cases, audits, and payer or regulatory inquiries
- Monitor regulatory changes and update policies and processes
- Oversee internal audits and external payer or regulatory reviews
- Supervise credentialing and licensing staff, including hiring, training, coaching, and performance management
- Build scalable staffing models aligned with client growth and service demand
- Conduct performance reviews and professional development planning
- Develop SOPs, training materials, and quality assurance frameworks
- 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
- Develop, price, and position credentialing and licensing services with executive leadership
- 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
- Act as subject matter expert in credentialing and licensing best practices
- Align credentialing with billing, appeals, eligibility, and denial management processes
- Provide executive-level oversight of credentialing-related impacts to revenue performance
Requirements
What you’ll need- 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
- Expert knowledge of Medicare, Medicaid, managed care, and commercial payer requirements
- Experience with quality management frameworks
- Demonstrated experience building, managing, and leading operational teams
- Experience with credentialing and PSV technology platforms
- Excellent time management and organizational skills
- Knowledge of NCQA credentialing standards preferred
- CPCS, CPMSM, or equivalent professional credentialing certification preferred
- Must be able to travel throughout and between facilities
- Must be able to perform sedentary work and meet the listed physical demands
Benefits
Comp & perks- Exempt employment
- Professional development planning
- Remote work arrangement