[Hiring] Payer Credentialing Manager @Theoria Medical

Role Description

We’re seeking a Payer Credentialing Manager to lead payer credentialing and re-credentialing processes for healthcare providers while ensuring compliance with accreditation standards, regulatory requirements, and organizational policies. This role includes oversight of payer enrollments, managing the payer credentialing team, maintaining data accuracy, and streamlining provider onboarding to reduce risk and support patient safety.

Key Responsibilities

• Oversee the processing of initial payer applications for health professionals, ensuring compliance with national accreditation standards and state/federal regulations.
• Maintain and manage payer credentialing databases and electronic records, ensuring accuracy, confidentiality, and audit readiness.
• Liaison with medical staff leadership, payers, licensure boards, and regulatory agencies to resolve credentialing issues promptly.
• Supervise payer credentialing staff by coordinating workloads, providing training, monitoring performance, and ensuring quality outcomes.
• Conduct regular audits of payer credentialing processes to identify gaps, implement corrective actions, and drive continuous improvement.

Qualifications

• Bachelor’s degree in healthcare administration, business, or related field.
• Minimum of 3 years in payer credentialing or healthcare administration.
• 1–3 years in a supervisory or managerial role.
• Demonstrated experience with payer enrollment processes.
• Hands-on experience with payer credentialing systems (e.g., CAQH, Medallion).
• Strong knowledge of databases and Microsoft Office applications (Excel, Access, Word).
• Strong organizational skills, attention to detail, communication, problem-solving, and knowledge of regulatory guidelines.

Benefits

• Competitive salary
• 401(k) with employer match
• Health, dental, and vision insurance
• PTO + paid holidays
• Life insurance coverage
• Remote flexibility with a national legal scope