[Hiring] Credentialing Manager @BETTERHEALTH A PLANNED PARENTHOOD PARTNERSHIP

Role Description

The Credentialing & Licensing Services Manager provides strategic and operational leadership for the organization’s credentialing, licensing, privileging, recredentialing, and payer enrollment programs. This role is accountable for ensuring all credentialing operations meet NCQA standards, federal and state regulatory requirements, payer specific guidelines, and internal quality benchmarks.

• Oversees the end to end credentialing lifecycle, including primary source verification, file completeness, documentation integrity, delegation oversight, and audit preparedness.
• Responsible for building scalable processes, implementing credentialing technology solutions, optimizing workflows, and ensuring timely, accurate enrollment of practitioners across all contracted payers.
• Supervises credentialing staff, drives performance and quality outcomes, and fosters a culture of accountability, service excellence, and continuous improvement.
• Collaborates closely with executive leadership, compliance, legal, revenue cycle, operations, and client-facing teams to ensure credentialing operations support organizational growth and enhance client experience.
• Serves as the primary liaison between senior leadership, clients, and credentialing teams ensuring transparent communication, issue resolution, and alignment on credentialing requirements, timelines, and service expectations.
• Contributes to new service development, assists with proposals and client onboarding, and supports strategic initiatives that expand the organization’s credentialing and licensing portfolio.

Qualifications

• Bachelor’s degree in healthcare administration, Business, or a related field (or equivalent experience).
• 5 to 8+ years of experience in provider credentialing, licensing, and payer enrollment.
• CPCS, CPMSM, or equivalent professional credentialing certification preferred.

Requirements

• Provide strategic oversight of credentialing, licensing, recredentialing, privileging, and payer enrollment operations.
• Establish departmental standards, policies, and performance metrics.
• Ensure compliance with federal, state, payer, and accreditation requirements.
• Serve as the escalation point for complex cases, audits, and payer or regulatory inquiries.
• Monitor regulatory changes and update policies and processes accordingly.
• Oversee internal audits and external payer or regulatory reviews.
• Directly supervise credentialing and licensing staff, including hiring, training, coaching, and performance management.
• Build scalable staffing models aligned with client growth and service demand.
• Conduct regular performance reviews and professional development planning.
• Foster a culture of accountability, quality, and continuous improvement.
• Assist the Associate Director of Quality Assurance with development of SOPs, training materials, and quality assurance frameworks related to credentialing and payer enrollment.
• Lead implementation and optimization of credentialing technology platforms and automation.
• Establish audit ready systems for documentation, tracking, and compliance reporting.
• Ensure consistent primary source verification and documentation standards.
• Partner with executive leadership to develop, price, and position credentialing and licensing services.
• Contribute to marketing materials, proposals, and client presentations.
• Support client discovery calls, solution design, and contract development.
• Identify new market opportunities and service line expansion.
• Collaborate with revenue cycle, compliance, legal, and operations teams to align services and workflows.
• Act as a subject matter expert in credentialing and licensing best practices.
• Partner with revenue cycle leadership to align credentialing with billing, appeals, eligibility, and denial management processes.
• Provide executive level oversight of credentialing related impacts to revenue performance.
• Ensure credentialing processes align with NCQA requirements.

Benefits

• Full-time employment with a salary range of $77,800 - $81,400.
• Remote work opportunity.
• Travel required.

Competencies

• Business Acumen, Strategic Thinking, Problem Solving.
• Customer Service and Interpersonal Skills, Oral and Written Communications.
• Ethics, Diversity, Initiative, Teamwork, Leadership.
• Computer and Technical Skills.
• Experience with quality management frameworks.
• Demonstrated experience building, managing, and leading operational teams.
• Expert knowledge of Medicare, Medicaid, managed care, and commercial payer requirements.

Skills

• Excellent time management and organizational skills.
• Experience with credentialing and PSV technology platforms.
• Willingness to learn new software and systems.
• Ability to gain trust and establish effective relationships with peers and leadership.
• Logical examination and interpretation of information to resolve problems.
• Understanding of the role that racial inequity plays in healthcare systems.
• Strategic leadership and operational execution.
• Team building and talent development.
• Regulatory and payer compliance expertise.
• Business and revenue growth mindset.
• Process design, automation, and optimization.
• Client relationship and service line development.
• Data-driven operational decision-making.