Credentialing Manager

At Jefferson Center, it is our policy and our mission to be inclusive and mindful of the diversity of everyone who comes through our doors. We are passionate about building a community where mental health matters and equitable care is accessible to all races, ethnicities, abilities, socioeconomic statuses, ages, sexual orientations, gender expressions, religions, cultures, and languages.

The Credentialing Manager oversees credentialing, payer enrollment, and re-credentialing processes for behavioral health providers at Jefferson Center for Mental Health. This role includes managing a credentialing team, ensuring compliance with all regulatory and payer requirements, and maintaining timely and accurate provider records to support clinical operations and revenue cycle integrity. The Credentialing Manager will work closely with clinical staff, leadership, and external partners to maintain accurate records, facilitate the application process, and ensure timely and efficient credentialing for all providers. The credentialing manager holds accountability for the successful completion of credentialing projects.

Key Responsibilities:

• Lead and manage a team of credentialing and payer enrollment specialists, providing training, guidance, and performance oversight.
• Oversee the credentialing, payer enrollment and re-credentialing processes for all clinical staff, including therapists, counselors, psychiatrists, and other providers.
• Create and maintain efficient workflows across the team to ensure that there is minimal lost revenue due to credentialing related denials.
• Monitor the credentialing team’s workflow to ensure efficiency and timely completion of tasks.
• Aid in verifying provider credentials through primary source verification in accordance with state and federal regulations, as well as insurance and payer requirements.
• Ensure compliance with all relevant regulatory bodies and standards, including federal, state, and payer-specific credentialing guidelines.
• Ensure credentialing processes support timely provider onboarding and minimize revenue disruption, with a focus on continuous process improvement.
• Maintain accurate and up-to-date records of provider credentials, licenses, certifications, and other required documentation.
• Track and report credentialing turnaround times, error rates, and provider onboarding success rates.
• Create and monitor KPI metrics to align with the centers strategic goals
• Liaise with insurance companies, Medicaid/Medicare, and other third-party payers to facilitate enrollment and updates for providers.
• Provide support in resolving issues related to credentialing and re-credentialing, including discrepancies or missing documentation.
• Stay current on all regulations and credentialing best practices, implementing changes and updates as needed to ensure ongoing compliance.
• Communicate effectively with healthcare providers regarding the status of their credentialing applications and any required documentation.
• Collaborate with leadership to ensure that credentialing policies and procedures align with the organization’s goals and regulatory requirements.
• Conduct periodic audits of credentialing and payer enrollment files to ensure all required information is complete, accurate, and up to date.
• Assist in training and educating new staff on credentialing policies and procedures.
• Facilitate and participate in departmental meetings by contributing to the development and improvement of operational processes.

Qualifications:

• Bachelor’s degree in healthcare administration, business, or related field; or equivalent work experience.
• Minimum of 2-3 years of experience in healthcare credentialing, preferably in a behavioral health or mental health setting, with at least 2-3 years of experience in a supervisory or leadership role.
• Strong experience managing or leading a team in a healthcare or administrative capacity.
• Knowledge of state, federal, and payer-specific credentialing requirements and guidelines.
• Experience with credentialing software and systems (e.g., CAQH, PECOS, etc.).
• Strong attention to detail and organizational skills.
• Ability to work independently and manage multiple priorities simultaneously.
• Excellent communication skills, both written and verbal.
• Strong problem-solving and analytical skills.
• Ability to maintain confidentiality and adhere to HIPAA regulations.
• Knowledge of NCQA standards.

Preferred Qualifications:

• Certification through the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) or similar credentialing certification
• Familiarity with mental health insurance networks and behavioral health policies.
• Ability to address quality improvement projects and complete process mapping.

Work Environment:

• This position will be a hybrid position with two days in the office at the Independence location and three days remote.
• Standard office hours are 8:30am to 5pm with flexibility depending on the needs of the department.

Salary Information: Grade 15 - $67,300 to $85,700*

Additional Salary Information*:

• The salary range above is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE.*

Application Deadline: 5/2/2025. Review of applications will begin immediately.

Equal Opportunity Employer
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