Clinical Credentialing Manager

Position Summary:

The Clinical Credentialing Manager is responsible for overseeing the credentialing, privileging, and re-credentialing processes for all clinical staff. This role ensures compliance with regulatory standards, payer requirements, and internal policies. The manager works cross-functionally with Human Resources, Clinical Operations, and Billing departments to support timely provider onboarding and ongoing credentialing accuracy.

Key Responsibilities:

• Credentialing & Recredentialing:
• Manage the full lifecycle of credentialing and recredentialing for physicians, therapists, and other licensed professionals.
• Submit and track provider applications with insurance panels and regulatory bodies.
• Ensure timely follow-up and resolution of any delays or discrepancies.
• Compliance & Audits:
• Maintain up-to-date and organized credentialing files and documentation.
• Ensure compliance with Joint Commission, NCQA, CMS, and state/federal regulations.
• Prepare for and participate in credentialing audits or payer revalidations.
• System Management & Reporting:
• Utilize credentialing software to manage records and generate regular status reports.
• Track licensure expirations, board certifications, DEA registrations, malpractice insurance, and other required documents.
• Monitor and ensure all providers maintain active credentials.
• Team Leadership & Support:
• Supervise credentialing specialists or administrative assistants (if applicable).
• Train and guide team members on credentialing best practices and updates.
• Serve as a subject matter expert and resource to clinical staff regarding credentialing.
• Relationship Management:
• Liaise with payers, licensing boards, and healthcare entities to facilitate timely credentialing.
• Support the onboarding process in collaboration with HR and Clinical Management.
  

Qualifications:

• Bachelor's Degree in Healthcare Administration, Business.
• Minimum 3–5 years of experience in provider credentialing, preferably in a behavioral health or multi specialty setting.
• Familiarity with CAQH, NPPES, PECOS, Medicare/Medicaid enrollment, and insurance paneling processes.
• Strong knowledge of credentialing compliance requirements and industry best practices.
• Proficiency with credentialing software and Microsoft Office Suite.
• Excellent attention to detail, communication, and organizational skills.