Manager, Credentialing

Zarminali Pediatrics is building the nation\'s leading pediatric multispecialty group, focused on supporting families to shape healthy futures for their children – from birth through adulthood – by completely transforming the way pediatric care is delivered nationwide. We are tackling today\'s challenges of increased administrative burden on clinicians and a siloed approach to pediatric care through intentional design of care delivery, enhanced by leading technology and collaborative, expert care teams. Our name, inspired by our founder\'s daughter\'s name – Zarmina – means "something that is more precious to you than gold". We couldn\'t think of anything that better represents the way parents and caregivers hold the relationship with their children as the most valuable gift, and how we at Zarminali approach care for each child with equal reverence. We strive for a healthier future for pediatric patients and a happier future for pediatric clinicians nationwide, and we are looking for people to join us in achieving this vision. If you are eager to join a growth stage company and be part of the early team that is shaping the foundation of both the company and the delivery of pediatric care, then this opportunity might be for you! POSITION OVERVIEW The Credentialing Manager will oversee and lead all credentialing and clinician enrollment activities for Zarminali physicians and advanced practice providers across multiple states. This role ensures that clinicians are properly credentialed, re-credentialed, contracted, and enrolled with payers, regulatory bodies, and facility networks. The Manager will also oversee relationships with external credentialing/enrollment vendors, ensuring accountability and performance. This position requires strong organizational skills, a deep understanding of payer rules, and the ability to manage multiple complex processes simultaneously. WHAT YOU’LL DO: Credentialing & Multi-State Enrollment Manage credentialing of new clinicians (MD, DO, NP, etc.): primary source verification, background checks, malpractice history, DEA, state licenses, board certifications. Coordinate payer enrollment across multiple states, ensuring clinicians are correctly set up for all practice locations, telehealth, and specialty services. Enroll clinicians into payer networks (Medicare, Medicaid, commercial insurers); ensure compliance with state-specific Medicaid requirements. Track enrollment timelines and escalate delays to minimize revenue disruption. Compliance & Regulatory Oversight Stay current on multi-state payer and state licensing regulations, including Medicaid enrollment rules and CLIA/state facility licensing where applicable. Ensure all credentialing files are audit-ready and compliant with NCQA, URAC, The Joint Commission, or state/federal guidelines. Coordinate with compliance/legal to address discrepancies, denials, or sanctions. Systems & Process Management Use credentialing/enrollment software (CAQH) and in-house databases. Ensure integration of credentialing data with EMR/RCM systems (AthenaHealth). Standardize workflows for clinician onboarding, re-credentialing, and payer enrollment across states. Vendor Oversight & Stakeholder Management Oversee external credentialing/enrollment vendors: evaluate performance, ensure SLA compliance, and hold vendors accountable for turnaround times and accuracy. Act as liaison between internal teams (HR, RCM, Finance, Operations) and external stakeholders (payers, hospitals, labs). Data Monitoring & Reporting Develop reporting dashboards for credentialing/enrollment pipeline across all states. Track KPIs: credentialing turnaround time, payer enrollment delays, denial trends, clinician readiness dates. Provide leadership with regular risk and compliance reports. Continuous Improvement Implement improvements in multi-state credentialing/enrollment workflows. Identify automation opportunities to reduce manual errors and improve accuracy. Train internal staff and practice managers on credentialing and payer enrollment processes. WHAT YOU’LL NEED: Bachelor\'s degree required; Master\'s preferred. CPCS, CPMSM, or similar certifications are strongly preferred. 5+ years of experience in provider credentialing and multi-state payer enrollment within a healthcare system, MSO, IPA, or large group practice. Familiarity with credentialing software and EMR systems (AthenaHealth strongly preferred). Strong knowledge of payer enrollment rules across Medicare, Medicaid, and commercial insurers. Experience overseeing vendor performance and contracts. Excellent organizational, analytical, and communication skills. Exposure to contracting/network participation agreements. Familiarity with multi-state telehealth regulations and enrollment requirements. WHAT WE OFFER: Be a part of a team-based environment focused on providing high quality pediatric care within a mission‑driven organization. Access to continuous learning, skill development, and career advancement within a supportive and dynamic culture. Competitive compensation package with paid time off, medical/dental/vision benefits, and others. Work in a newly designed and advanced clinic that emphasizes patient comfort and top‑notch care in a welcoming and calming environment. At Zarminali Pediatrics, we are committed to our empowering clinicians and team members to deliver better pediatric care, altogether. This commitment requires building an inclusive culture and a team that represents the diverse communities we serve. We believe that when people from all backgrounds, experiences, and perspectives come together, we create a stronger team and better care for our patients and their families. We realize the importance of an environment where clinicians and team members feel cared for, supported, and valued. We believe in the basics: treating everyone with kindness, respect, and fairness. We do not tolerate discrimination or harassment of any kind. This includes, but is not limited to, race, color, sex, gender, age, religion or religious creed, national origin, ancestry, citizenship, marital status, sexual orientation, gender identity, gender expression, genetic information, physical or mental disability, military or veteran status, or any other characteristic protected by law. We recruit and hire based on skills, talent, and potential, ensuring everyone has a fair chance to succeed. Together, we strive to build an inclusive and welcoming space where we can achieve our goal of building a happier future for the pediatric workforce. #J-18808-Ljbffr