Credentialing Manager

This is an opportunity for an experienced healthcare operations professional to lead provider credentialing and enrollment while building strong, lasting client relationships. You will oversee the full credentialing lifecycle, ensuring provider information, payer applications, and enrollment processes remain accurate, efficient, and compliant. Working closely with clients, providers, payers, and internal leadership, you will serve as a trusted point of contact for operational matters and complex issues. You will also guide teams, strengthen workflows, and introduce scalable processes that improve service quality and provider experience. Through performance monitoring and strategic planning, you will help identify opportunities for improvement and support continued organizational growth. This remote leadership role combines client success, operational ownership, and people management in a fast-paced healthcare services environment.

• Serve as the primary contact for assigned clients, responding proactively to questions, concerns, and operational needs.

• Lead regular client meetings to review credentialing and provider enrollment performance, discuss challenges, and align on priorities and objectives.

• Monitor and analyze key performance indicators, including client retention and turnover, credentialing turnaround times, network adequacy, and Net Promoter Score (NPS).

• Oversee provider enrollment, initial credentialing, and re-credentialing activities, ensuring accuracy, timely completion, and compliance with payer requirements.

• Maintain reliable tracking, reporting, and documentation of enrollment status, payer communications, and provider information across internal systems.

• Act as the senior point of contact for complex provider, payer, and claims-related issues.

• Oversee the effective use and maintenance of CAQH profiles, payer applications, and internal credentialing databases.

• Identify and implement improvements that simplify workflows, reduce processing times, and enhance the provider experience.

• Establish consistent standard operating procedures, reporting frameworks, and quality controls across the Provider Relations function.

• Analyze operational trends, performance metrics, and workflow bottlenecks to guide decisions and continuous improvement initiatives.

• Support departmental strategy and operational scaling as services expand nationally.

• Coordinate with internal teams, including Revenue Cycle, Operations, Compliance, and Clinical Leadership, to ensure effective collaboration.

• Deliver leadership-level updates and reports on enrollment progress, operational risks, and capacity planning.

• Maintain clear, professional communication with providers, clients, payers, and external partners.

• At least 5 years of experience in provider relations, credentialing, provider enrollment, or healthcare operations.

• At least 2 years of people management experience, including responsibility for Team Leads or supervisors.

• At least 2 years of account management or customer success experience, serving as the primary contact for client relationships.

• Strong understanding of medical billing, payer enrollment, claims resolution, and broader healthcare operations and workflows.

• Demonstrated ability to lead teams, establish accountability, and develop processes that can scale with business growth.

• Bachelor's degree required; a degree in healthcare administration, business, or process improvement is preferred.

• Excellent organizational, analytical, and reporting capabilities, with the ability to monitor performance and translate data into actionable improvements.

• Strong written and verbal communication skills, including the ability to build relationships and influence stakeholders across different levels and functions.

• Proficiency in Microsoft Office applications and credentialing or provider enrollment databases.

• Ability to manage competing priorities and adapt effectively in a fast-paced, evolving environment.

• Strong attention to detail, sound judgment, and effective problem-solving and decision-making skills.