Credentialing Manager

Job Description

Job Description

A healthcare company is looking for an experienced Credentialing Manager to lead credentialing and provider data activities for a healthcare organization in Long Beach, California. This Credentialing Manager position will guide daily operations related to provider onboarding, recredentialing, enrollment support, and data accuracy while maintaining adherence to regulatory and health plan standards. The Credentialing Manager also partners with internal leaders to strengthen workflows, support audit readiness, and promote consistent credentialing practices across the function.

Key Responsibilities:

• Direct the day-to-day work of credentialing and provider data staff, setting priorities and providing operational guidance.

• Lead provider onboarding, reappointment cycles, payer enrollment activity, and privileging coordination to keep processes moving efficiently.

• Maintain compliance with applicable accreditation standards, delegated credentialing obligations, and state and federal regulations.

• Review credentialing records, provider rosters, and supporting documentation to ensure information remains complete, current, and accurate.

• Track team volume and turnaround times, remove workflow obstacles, and support timely resolution of credentialing issues.

• Prepare the department for internal and external reviews by conducting audits and addressing gaps before formal assessments occur.

• Work with leadership to refine credentialing policies, improve reporting, and enhance departmental procedures.

• Oversee provider data integrity across systems and records to support reliable downstream use and regulatory reporting.

Benefits: Health, Dental, Vision, 401k, and Sick Time Off.

Qualifications:

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related discipline.

• At least 5 years of experience in managed care credentialing, including 1 or more years in a lead or supervisory capacity.

• Strong understanding of delegated credentialing, payer enrollment requirements, recredentialing practices, and provider file management.

• Knowledge of state, federal, regulatory, and accreditation expectations related to credentialing operations.

• Experience using credentialing platforms and maintaining provider databases; familiarity with MD-Staff is preferred.

• Ability to manage multiple priorities, monitor compliance, and support audit preparation in a healthcare environment.

• Certification in credentialing is considered an advantage.

• Background in healthcare managed care settings is strongly preferred.