Credentialing Manager

Credentialing Manager
Onsite only - Lehi, Utah

Job Overview:
The Credentialing Manager is responsible for overseeing and managing the credentialing and re-credentialing processes for all behavioral health providers within the organization. This role ensures that all providers meet the necessary licensing, accreditation, and regulatory requirements, ensuring the highest standards of care are delivered to our patients. The Credentialing Manager will work closely with healthcare professionals, insurance companies, and regulatory bodies to ensure compliance and maintain accurate provider records.

Key Responsibilities:

• Oversee the complete credentialing process for behavioral health providers, including physicians, therapists, counselors, and other clinical staff.
• Ensure all new providers are credentialed accurately and efficiently, ensuring compliance with local, state, and federal regulations.
• Manage and track re-credentialing for all providers, ensuring timely submission of documents and approvals to maintain active status with insurance networks.
• Review and verify provider licensure, certifications, and other relevant credentials to ensure compliance with the company's policies and applicable regulations.
• Develop and maintain strong relationships with external agencies, regulatory bodies, and insurance payers to facilitate the credentialing process.
• Assist with any audits and compliance checks related to credentialing and licensing.
• Maintain accurate and up-to-date provider records and databases, ensuring that documentation is complete and easily accessible for regulatory or operational needs.
• Collaborate with HR, billing, and operations teams to ensure smooth integration of credentialed providers into the organization.
• Stay current with changes in federal and state regulations related to credentialing and provider accreditation.
• Provide guidance and support to internal teams and providers regarding credentialing requirements and timelines.
• Prepare and submit reports on credentialing status to senior leadership as requested.
• Manage the ongoing monitoring of provider status, including expiring certifications, licenses, and insurance agreements.

Qualifications:

• Bachelor's degree in healthcare administration, business, or a related field; or equivalent work experience in credentialing, compliance, or healthcare operations.
• Experience with behavioral health providers and understanding of behavioral health-specific credentialing needs.
• Minimum of 3-5 years of experience in credentialing within the healthcare or behavioral health field, with a focus on provider enrollment and insurance network management.
• Knowledge of regulatory requirements for healthcare providers and experience with industry standards for credentialing and re-credentialing.
• Strong understanding of the credentialing software and databases.
• Ability to maintain confidentiality and handle sensitive information.
• Excellent organizational skills and attention to detail.
• Strong written and verbal communication skills.
• Ability to manage multiple tasks and priorities in a fast-paced environment.

Benefits

• Competitive pay (DOE)
• Medical, Dental and Vision Insurance
• Life Insurance
• 401k
• Paid Time off
• 10 Major Holidays Off

About

At Serenity, we give our patients long-term success even when other treatments have failed. We are committed to creating the finest patient experience and ensure this by investing in our employees through cultivating a culture that is people-centric, collaborative, positive, proactive, and open to opportunity for personal and professional development.