Job Description

Position Summary:
The Clinical Credentialing Manager is responsible for overseeing the credentialing, privileging, and re-credentialing processes for all clinical staff. This role ensures compliance with regulatory standards, payer requirements, and internal policies. The manager works cross-functionally with Human Resources, Clinical Operations, and Billing departments to support timely provider onboarding and ongoing credentialing accuracy.
Key Responsibilities:
Credentialing & Recredentialing:
Manage the full lifecycle of credentialing and recredentialing for physicians, therapists, and other licensed professionals.
Submit and track provider applications with insurance panels and regulatory bodies.
Ensure timely follow-up and resolution of any delays or discrepancies.
Compliance & Audits:
Maintain up-to-date and organized credentialing files and documentation.
Ensure compliance with Joint Commission, NCQA, CMS, and state/federal regulations.
Prepare for and participate in credentialing audits or payer revalidations.
System Management & Reporting:
Utilize credentialing software to manage records and generate regular status reports.
Track licensure expirations, board certifications, DEA registrations, malpractice insurance, and other required documents.
Monitor and ensure all providers maintain active credentials.
Team Leadership & Support:
Supervise credentialing specialists or administrative assistants (if applicable).
Train and guide team members on credentialing best practices and updates.
Serve as a subject matter expert and resource to clinical staff regarding credentialing.
Relationship Management:
Liaise with payers, licensing boards, and healthcare entities to facilitate timely credentialing.
Support the onboarding process in collaboration with HR and Clinical Management.
Qualifications:
Bachelor's Degree in Healthcare Administration, Business.
Minimum 3–5 years of experience in provider credentialing, preferably in a behavioral health or multi specialty setting.
Familiarity with CAQH, NPPES, PECOS, Medicare/Medicaid enrollment, and insurance paneling processes.
Strong knowledge of credentialing compliance requirements and industry best practices.
Proficiency with credentialing software and Microsoft Office Suite.
Excellent attention to detail, communication, and organizational skills.

Job Tags

Work at office,

Similar Jobs

Shangri-La Springs

General Maintenance Worker Job at Shangri-La Springs

...housekeeping services to the buildings and grounds on the historic property of Shangri-La Springs. This is an entry level position. No experience necessary.The ideal candidate willbe able to work unsupervised and complete work in a timely and efficient manner, and...

Verneek

Digital Marketing Designer Job at Verneek

...something creative every day while working at the cutting edge of AI, Verneek could be a perfect opportunity for you: a deep-tech AI startup, where you'd get to learn, innovate, and leave your mark every single hour of every day. We are looking for stellar & highly...

Delta-T Group Inc.

Residential Aide Job at Delta-T Group Inc.

...Location: Concord, MA Date Posted: 06/30/2025 Category: Residential Education: With over 30 years in business, the Delta-T Group has built a reputation for referring highly qualified professionals for rewarding short and long-term independent contract opportunities...

Gpac

Senior Civil Designer - Land Development - 100% REMOTE WORK Job at Gpac

...please apply with a resume. If you have any other questions or wish to discuss any other positions, reach out to Lauren Murtagh with gpac at or . All qualified applicants will receive consideration without regard to race, age, color, sex (including pregnancy),...

Allegiance Group

Office Administrator Job at Allegiance Group

Office Administrator Construction Industry Location: Mystic, CT Salary: $75,000 $95,000 (depending on experience) Were looking for an experienced Office Administrator to join our team in Mystic, Connecticut . This is a key position within our growing ...

Clinical Credentialing Manager Job at Backpack Healthcare, Baltimore, MD

dEI2MHpYWUluV1lWeDlvYjBrWG4wUS9yMlE9PQ==