Credentialing Manager (Remote)

Job Description

Job Description

Title: Credentialing Manager

Reports to: VP Client Success

FLSA Classification: Exempt

Full-Time

Salary Range: $60,000 – $70,000

Position Overview: The Credentialing Manager is responsible for overseeing provider and facility credentialing and payer enrollment activities to ensure timely submissions, consistent follow-up, and accurate documentation through completion. This role leads and supports Provider Enrollment & Privileging Specialists, maintains records within credentialing systems and tracking tools, partners cross-functionally with Billing and Collections to resolve credentialing-related claim issues, and delivers routine reporting and trend insights to leadership.

Key Responsibilities

Leadership & Team Oversight

• Directly oversees onshoreProvider & PrivilegingSpecialists, including daily workflow management, performance support, and accountability to deadlines and quality standards.
• Provides training, coaching, and ongoing process guidance to credentialing team members; supports onboarding and skill development.
• Monitors team adherence to documentation and file maintenance standards, including management of expirable documents and renewals/re-credentialing.
• Reviews department policies and procedures and recommends updates based on trends, payer changes, and operational needs.

Credentialing & Payer Enrollment Operations

• Oversees Medicare, Medicaid, and Commercial payer credentialing procedures for all assigned accounts.
• Manages provider enrollment and credentialing processes end-to-end, ensuring all facilities/providers are appropriately credentialed with required payers.
• Completes andsubmitsin-network participation requests and applications for facilities and/or providers as applicable.
• Performs ongoing follow-up on pending enrollments and escalates issues appropriately;assistsSpecialists with follow-up phone calls when needed.
• Conducts research todeterminecredentialing requirements prior to onboarding, including payer prerequisites and facility readiness.

Cross-Functional Collaboration & Claims Support

• Partnerswith Client Success Management, andOperationsleadership to improve process accuracy, reduce credentialing-related billing delays, and meet performance goals.
• Acts as liaison with payers related to credentialing issues that impact claims (e.g., participation status discrepancies, effective dates, missing enrollments).
• Supports facility payer contracting coordination where applicable, ensuring alignment between payer participation status and operational workflows.

Documentation, Systems, and Data Integrity

• Maintainsaccurateandtimelydocumentation in credentialing systems,Modio,SmartsheetandSalesforceand tracking tools/spreadsheets.
• Ensures facility and provider records are current, including licenses, contact information, documentation, and credentialing status.

Compliance & Monitoring

• Ensures compliance with HIPAA and company policies and procedures.
• Completes monthly OIG/SAM monitoring and documentation (or ensures completion/validation by the team).
• Ensures credentialing documentation protocols are followed consistently across accounts and team members.

Reporting & Deliverables

• Providesmonthlycredentialinginvoicingreporting toFinance.
• Provides regular updates on client health for Credentialing to Management team,including status updates, risks, barriers, and trends.
• Maintains ongoing weekly/monthly credentialing activity reporting (e.g., Credentialing Matrix).
• Identifiestrends and recurring barriers in credentialing activity, communicates impacts, and recommends solutions.

Other Duties

• Executes special projects and otherduties asassigned.
• Participates in companywide and departmental meetings.
• Delivers excellent customer service whilemaintainingprofessionalism in a team-based environment.

Skills & Competencies

• Self-motivated and detail-oriented with a strong operational and deadline-driven mindset.
• Strong knowledge of provider/facility credentialing, enrollment workflows, re-credentialing, and expirable document management.
• Results-oriented withabilityto implement and manage cross-functional initiatives.
• Proficient with credentialing systems and able to learn new tools/processes quickly.
• Effective communicator with strong written, verbal, and stakeholder-management skills (including physician offices and facility contacts).
• Strong organizational and prioritization skills; able to manage multiple workflows and competing deadlines.
• Sound judgmentregardingwhen to act independently and when to escalate or seek guidance.
• Demonstrates flexibility, professionalism, and customer focus.

Required Qualifications

• 3–4 years of credentialing experience (or equivalent related experience).
• Experience working with online payer portals and payer resources.
• Working knowledge of billing andcollectionsworkflows; accounts receivable experience is a plus.
• Proficiencyin Microsoft Office (Excel, Outlook, Word); ability tomaintaintracking logs and reporting.
• Excellent interpersonal skills and ability to work effectively in a team environment.

Preferred Knowledge/Experience

• Familiarity with facilitycredentialing and licensingconsiderations across multiple states.
• Experience supporting credentialing forphysician services, radiology, urology, hospitalist,behavioralhealthand/or multi-facility organizations (if applicable to your environment).

Supervisory Responsibility

This position has direct supervisory responsibilities.

Additional information: 

Coronis Health is committed to creating a diverse and inclusive environment where all employees are treated fairly and with respect. We are an equal-opportunity employer, providing equal opportunities to all applicants and employees regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or any other protected characteristic. We welcome and encourage applications from candidates of all backgrounds. 

Acknowledgement: I have read the job description and completely understand all of the duties and responsibilities. I am able to perform the essential functions as outlined.