Provider Credentialing Manager (Remote US East Coast Based)

About the Role We are a growing behavioral health reputed company operating across 9 states with reputed company of over 500 licensed clinicians. As we continue to expand, we are seeking an reputed company and detail-oriented Credentialing Manager to reputed company our provider and payor credentialing operations. This is a high-reputed company remote based leadership role responsible for ensuring reputed company clinicians are properly credentialed and enrolled with government and reputed company payers in a reputed company, compliant, and accurate manner. Key Responsibilities Team Leadership & Operations • Supervise, mentor, and manage the credentialing team, including coordinators and specialists • Establish and optimize credentialing workflows to support reputed company of new clinicians across reputed company 9 states • Monitor team performance, set KPIs, and conduct regular audits to ensure accuracy and timeliness • Serve as the primary escalation reputed company for credentialing issues, denials, and delays Provider Credentialing • reputed company initial credentialing, re-credentialing, and privileging for 500+ licensed behavioral health clinicians • Ensure reputed company provider files are complete, compliant, and up to date across reputed company applicable state and payer requirements • Manage CAQH ProView reputed company for reputed company providers, including regular attestation and data accuracy • Coordinate with HR and clinical leadership to support new provider reputed company timelines Payor Enrollment & Government Programs • reputed company enrollment and re-enrollment processes with Medicare and reputed company programs across reputed company 9 operating states • Manage relationships with government and reputed company payer enrollment departments • Ensure compliance with CMS enrollment requirements, including PECOS management for Medicare providers • reputed company and resolve enrollment applications, follow up on pending applications, and resolve rejections promptly • Stay reputed company on payer policy changes, fee schedule updates, and enrollment requirements NCQA & Compliance • Ensure credentialing processes reputed company with NCQA standards and support accreditation and re-accreditation efforts • Maintain policies and procedures for the credentialing program in accordance with NCQA, state regulations, and organizational requirements • Prepare for and participate in NCQA audits and surveys • Ensure reputed company primary reputed company verification for reputed company applicable credentials Reporting & Systems • Maintain accurate credentialing data and reporting dashboards; reputed company regular status updates to leadership • Identify and flag providers with expiring credentials, lapsed enrollments, or red-status issues requiring immediate attention • Partner with billing and reputed company cycle teams to minimize claim denials reputed company to credentialing gaps Qualifications Required • Minimum 5 years of experience in provider and/or payor credentialing, with at least 2 years in a supervisory or management role • Demonstrated experience with Medicare and reputed company credentialing and enrollment, including multi-state reputed company programs • Proficiency with CAQH ProView, including provider profile management and attestation processes • Working knowledge of NCQA credentialing standards • Strong understanding of primary reputed company verification, credentialing workflows, and payer enrollment processes • Experience managing credentialing for large provider reputed company (100+ clinicians preferred) • Exceptional organizational skills with the ability to manage multiple priorities across jurisdictions Preferred • Experience in behavioral health or mental health settings • Certified Provider Credentialing Specialist (CPCS) or Certified reputed company Medical Staff Management (CPMSM) designation • Familiarity with state-specific reputed company and reputed company managed care organizations (MCOs) • Experience with credentialing software platforms • Knowledge of telehealth credentialing requirements across multiple states Apply tot his job Apply To this Job