Job Description

Job Summary 

The Manager, Credentialing is responsible for overseeing the credentialing and re-credentialing processes for healthcare providers within the organization. This role ensures compliance with regulatory and accreditation standards, manages credentialing operations, and maintains accurate records of provider credentials. The Manager collaborates with medical staff, facility leadership, and external agencies to streamline processes, uphold quality standards, and support patient safety and care quality. 

Essential Functions

Develops, implements, and monitors credentialing and re-credentialing policies and procedures to ensure compliance with regulatory standards. Oversees the credentialing operations, including application processing, primary source verification, and documentation management. Ensures the maintenance of accurate and complete credentialing records, coordinating with medical staff and relevant departments. Reviews and improves credentialing workflows and processes to enhance accuracy, efficiency, and compliance. Manages relationships with accrediting bodies, regulatory agencies, and external vendors to maintain industry-standard credentialing practices. Prepares and presents reports on credentialing metrics, status updates, and quality improvement initiatives to facility leadership. Acts as a resource on credentialing matters, staying informed of changes in regulatory and accreditation standards. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

Associate Degree in Healthcare Administration, Business, or a related field required 3-5 years of experience in credentialing required 1-2 years of supervisory or management experience preferred

Knowledge, Skills and Abilities

Knowledge of credentialing processes, regulatory standards, and accreditation requirements. Strong leadership and team management skills to guide and develop credentialing staff. Analytical skills for quality control, process improvement, and data management. Excellent communication and collaboration skills to interact with internal teams and external agencies. Organizational skills to manage detailed records, regulatory compliance, and workflow efficiencies.

Licenses and Certifications

CPMSM - Certified Professional Medical Services Management required or Certified Provider Credentialing Specialist (CPCS) required