Credentialing Manager

Position Title: Credentialing Manager
Reports to: Director of Contracting & Credentialing
FLSA Classification: FTE
Direct Reports: Yes
HYBRID: Office/ Remote

Commonwealth Pain & Spine is a pain management network dedicated to improving the lives of our patients by treating their pain with the utmost respect and providing them with the most innovative, safe, responsible, and clinically proven pain relief possible.
Our team of best-in-class physicians, administrators, and staff empathizes with the needs of our patients. We recognize that their pain is exhausting and debilitating and limits their quality of life. Relief from chronic pain is achievable in various degrees through our intelligent and multimodal team-based approach. Our entire team is committed to providing levels of patient satisfaction and overall clinical outcomes that far exceed the expectations of the medical community, referring physicians, and our customers.

Benefits:

• Competitive compensation
• Comprehensive Health/Vision/Dental insurance options
• Great PTO plan PLUS Paid Holidays
• 401k and matching available

Commonwealth Pain and Spine is an Equal Employment Opportunity Employer!

Job Summary:
The Credentialing Manager is responsible for overseeing and managing the credentialing and re-credentialing processes for healthcare providers within the organization. This role ensures compliance with accreditation, regulatory, and payer requirements while maintaining accurate provider records. The Credentialing Manager will lead the credentialing team, streamline processes, and work closely with payers, providers, and internal departments.

Job Responsibilities

• Manage and oversee the credentialing and re-credentialing process for all healthcare providers, ensuring compliance with state, federal, and payer requirements.
• Maintain up-to-date provider records, including licensure, certifications, and other credentialing documents.
• Develop and implement policies and procedures for credentialing to ensure efficiency and compliance.
• Collaborate with payers, regulatory bodies, and internal teams to resolve credentialing-related issues.
• Ensure timely submission and follow-up on credentialing applications and payer enrollments.
• Supervise and train credentialing staff, setting clear performance expectations, and monitoring productivity.
• Manage credentialing audits and inspections, ensuring readiness for accreditation bodies such as The Joint Commission, NCQA, AAAHC and CMS.
• Maintain knowledge of industry regulations and changes that may impact credentialing and payer enrollment processes.
• Implement and optimize credentialing software or databases for tracking provider information and status updates.
• Prepare reports on credentialing status, performance metrics, and compliance requirements for leadership.
• Address and resolve provider enrollment issues that may impact claims processing and reimbursement.

Required Skills and Qualifications

• Minimum of 3-5 years of experience in healthcare credentialing, with at least 2 years in a leadership role.
• Strong knowledge of credentialing standards, payer enrollment, and compliance requirements.
• Familiarity with accreditation organizations such as The Joint Commission, NCQA, AAAHC and CMS.
• Proficiency in credentialing software and databases.
• Excellent organizational, communication, and problem-solving skills.
• Ability to work collaboratively across departments and manage multiple priorities.
• High attention to detail and ability to ensure accuracy in provider records.

Preferred Skills:

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).

• Experience in a multi-state or large healthcare organization.
• Knowledge of electronic health records (EHR) and payer enrollment portals.

Education:

• Bachelor’s degree in healthcare administration, business, or a related field (preferred) or equivalent experience.

Physical Requirements:
The physical demands of this position will include sitting and standing with occasional light to medium lifting. An employee must meet these requirements to successfully perform the essential duties of this job. Reasonable accommodation will be made in accordance with ADA rules and regulations.