Credentialing Manager

Midwest Eye Consultants

. Oversee all aspects of payer enrollment, recredentialing, and ongoing maintenance of provider participation in insurance networks .

Posted 9/29/2026full-timeRemote • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in payer enrollment, credentialing processes, and compliance with NCQA and CMS standards. Proven ability to lead teams, manage relationships with insurance plans, and implement process improvements in a healthcare setting.

Highest-signal resume keywords

Payer Enrollment ManagementCredentialing Lifecycle OversightNCQA Compliance KnowledgeCPCS or CPMSM CertificationOptometry/Ophthalmology Experience

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Credentialing Database MaintenanceCPT, ICD-10, and HCPCS Code KnowledgePECOS UpdatesCAQH MaintenanceDelegated CredentialingManaged Care ContractingKPI DevelopmentOperational ExcellenceProcess ImprovementProject Management

Soft Skills

Advanced Communication SkillsInfluence and Negotiation SkillsCross-Functional CollaborationAttention to DetailProfessional Integrity

Tools & Technologies

Microsoft Office

Certifications & Qualifications

CPCS CertificationCPMSM Certification

Industry Keywords

Payer StandardsInsurance NetworksOutpatient HealthcareProvider EnrollmentCredentialing Workflows

About the role

Key responsibilities & impact

Oversee all aspects of payer enrollment, recredentialing, and ongoing maintenance of provider participation in insurance networks
Manage the end-to-end credentialing lifecycle, including initial credentialing, recredentialing, and expiration tracking
Oversee payer enrollment applications, PECOS updates, CAQH maintenance, NPPES records, and delegated agreements
Monitor compliance with NCQA, CMS, and commercial payer standards
Maintain an accurate credentialing database
Lead, supervise, and support Provider Enrollment Specialists
Establish, document, and refine credentialing workflows, SOPs, and KPIs
Act as the primary liaison with insurance plans to resolve enrollment delays or issues
Monitor payer policy updates and state/federal regulations
Support credentialing-file audits
Provide weekly and monthly updates on credentialing status and turnaround times
Track and report pending expirations to avoid lapses
Prepare credentialing rosters and enrollment summaries
Champion company culture and commitment to patient care
Align strategic goals and resources to maximize profitability
Collaborate across the organization to develop scalable solutions
Participate in integration and post-acquisition teams as needed
Drive operational excellence and maintain compliance
Recruit, hire, train, motivate, retain, guide, and evaluate employees

Requirements

What you’ll need

Bachelor’s degree or equivalent experience required
3-5 years of credentialing experience
2+ years in a supervisory role
Experience in optometry/ophthalmology or outpatient healthcare preferred
Experience in delegated credentialing and/or managed care contracting preferred
CPCS or CPMSM certification preferred
Knowledge of NCQA, CMS, and commercial payer standards
Proficiency in Microsoft Office
Strong knowledge of CPT, ICD-10, and HCPCS codes relevant to optometry/ophthalmology
Knowledge of insurance guidelines relevant to optometry/ophthalmology
Strategic relationship management
Advanced communication skills
Influence and negotiation skills
Cross-functional collaboration
Process improvement and problem solving
Project and time management
Attention to detail and professional integrity
Ability to communicate effectively through verbal and written means
Ability to hear and understand spoken information in-person and via electronic means
Visual acuity to ensure accuracy of work on screens and documents
Ability to maintain focus and attention to detail for extended periods

Benefits

Comp & perks

Remote position
Reasonable accommodations may be provided to qualified individuals with disabilities
Professional office and/or remote office setting
Equal Opportunity Employer