Compliance and Credentialing Manager | Posted 8-9-2021

About the Role and Responsibilities:

We are seeking a talented and experienced Compliance and Credentialing Manager to add to our team. The Compliance and Credentialing Manager is responsible for managing the initial credentialing, re-credentialing and the continuous credentialing processes for individual and organizational Providers, supervision of credentialing staff, maintenance of the integrity of Provider data and contracts in credentialing files, and in the credentialing database, compliance with regulatory and accreditation standards. Facilitating regulatory audits, cooperating with credentialing Contract plans’ delegation oversight audits, and conducting internal audits. The manager is also responsible for performance expectations related to compliance and credentialing quality control, delegation oversight of credentialing vendors, and departmental goals. The manager collaborates with fellow leadership, co-workers, network providers, and staff in other departments to achieve departmental and organizational objectives and to deliver exceptional Provider Services. The manager also fosters an environment of continuous learning, staff development, and performance improvement through defined metrics.

Core Qualifications:

  • Bachelor’s degree in Health Care Administration or Business-related discipline or 4 years of related experience.
  • NAMSS Certification (CPCS or CPMSM) strongly preferred or eligibility to acquire within 12 months after date of hire.
  • Four years of experience in the following areas: Hospital Credentialing, Health Plan Credentialing.
  • Two years of management experience in auditing and managing a credentialing department.
  • Two years of active collaboration experience with auditors.
  • Strong attention to detail, critical thinking, problem solving and analytical skills.
  • Demonstrated ability to work collaboratively, multi-task and meet deadlines in a complex, rapidly evolving environment with staff across the organization/departments.
  • Proficiency in MS Office suite.
  • Strong interpersonal, communication, organizational and time/project management skills are essential.
  • Excellent written and verbal communication skills.

We are an Equal Opportunity/Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: poster_screen_reader_optimized.pdf

Please, e-mail your résumé along with cover letter to

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