Credentialing Manager

Job Description

Job Description

About the Role

We are seeking an experienced Credentialing Manager to lead provider credentialing operations and data integrity across multiple healthcare systems. This role is responsible for ensuring accurate, compliant, and up-to-date provider information across CRMs, data platforms, PECOS, and population health systems. The ideal candidate has strong leadership, analytical, and compliance skills, with a passion for improving healthcare operations and data quality.

Key Responsibilities

Oversee provider data accuracy and integrity across CRMs, PECOS, and population health systems through audits, reconciliations, and continuous updates.

Develop, implement, and maintain internal credentialing and compliance policies.

Prepare and present monthly reports on provider data, attribution, and compliance metrics.

Ensure timely completion of HIPAA attestations, Security Risk Assessments, and staff training.

Manage CMS and PECOS updates, including provider Adds / Removes and documentation submissions.

Oversee legal documentation, provider participation agreements, and ACO contracts with accurate tracking and recordkeeping.

Coordinate ACO-MS submissions and ensure compliance with MSSP and 4i program deadlines.

Lead internal communications, newsletters, and organizational updates to ensure consistent messaging.

Collaborate with Contracting, Compliance, and Data Analytics to align provider workflows and data accuracy.

Create and maintain dashboards to track performance, productivity, and compliance goals.

Lead CRM optimization, automation initiatives, and system enhancements to improve efficiency.

Supervise credentialing staff, ensuring accountability, training, and performance management.

Support onboarding / offboarding processes and assist with external hiring and growth projects.

Drive process improvement and workflow automation to reduce manual credentialing tasks.

Key Performance Metrics

Data Integrity : ≥ 98% accuracy across credentialing systems.

Compliance : 100% of CMS / PECOS updates completed within 30 days.

Timeliness : All reports and submissions completed by deadlines.

Efficiency : Annual 10% reduction in manual credentialing processes.

Team Development : Quarterly training completion for all credentialing staff.

Qualifications

Bachelor’s degree in Healthcare Administration, Business, or related field (Master’s preferred).

5+ years of experience in healthcare operations, provider data management, or network administration.

2+ years of leadership or supervisory experience.

Knowledge of PECOS, CMS provider assignment, and ACO attribution preferred.

Proficiency in Salesforce , ACT! , or similar CRMs.

Strong Microsoft Excel and data analysis skills.

Excellent written, verbal, and interpersonal communication abilities.

Proven experience implementing workflow improvements and compliance initiatives.