Credentialing & Provider Enrollment Manager
New
C
Charlie HealthBehavioral Healthcare
Please note that this role is not available to candidates in Alaska, Maine, Washington DC, New Jersey, California, New York, Massachusetts, Connecticut, Colorado, Washington State, Oregon, or Minnesota.Full-TimeManager
Salary70,000 - 77,500 USD per year
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Job Details
- Languages
- English
- Experience
- 5+ years of experience in provider credentialing and/or health plan enrollment
- Required Skills
- SalesforceProcess improvement
Requirements
- Bachelor’s degree
- 5+ years of experience in provider credentialing and/or health plan enrollment
- Direct, hands-on experience owning or operating a delegated credentialing program
- 2+ years of people management experience leading a credentialing or enrollment team preferred
- Experience with both Medicaid and Commercial payor enrollment
- Comfort with process improvement and a track record of leveraging automation and emerging technologies (including AI)
- Strong cross-functional collaboration skills across RevOps, RCM, Commercial Strategy, and Compliance
- Native or bilingual English proficiency
- Familiarity with cloud-based communication software: Google Suite, Slack, Zoom, Dropbox, Salesforce
Responsibilities
- Lead, manage, and develop a team of 5+ credentialing specialists, owning team KPIs including enrollment turnaround times and applications submitted & approved
- Own and operate the delegated credentialing program end-to-end, including provider onboarding, primary source verification, and maintaining NCQA-aligned standards
- Lead the internal credentialing committee — presenting cases, maintaining meeting minutes, and managing approvals
- Manage required payor audits and internal audits to ensure ongoing NCQA and delegated credentialing compliance
- Set and drive long-term credentialing strategy, partnering with Commercial Strategy to expand delegated credentialing statuses across payors
- Build and maintain a centralized “Credentialing Source of Truth” documenting payor-specific requirements
- Partner with RevOps to align on KPIs and incentive structure, and with RCM to troubleshoot problem payors and credentialing-related denials
- Identify and implement process improvements that increase team efficiency, including automation and AI-enabled workflows
- Oversee day-to-day payor and Medicaid enrollment across group and individual submissions, ensuring timely, accurate, and compliant applications tracked in Salesforce
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