Credentialing Manager and Provider Enrollment (remote)

Job Description

Job Description

Credentialing Supervisor - Provider Enrollment (Remote)

Remote or Southfield, MI 48075

Pay: $75,000-85,000 Annually

Benefits:

Medical Insurance

Dental Insurance

Vision Insurance

401(k) with Match

3 Weeks PTO

Paid Legal Holidays

Life Insurance

Perks:

Growing Healthcare Organization

Remote work

Dynamic and Fast-Paced Work Environment

Full-Time Position

About Us:

At Vascular Centers of America, we are an outpatient vascular clinic specializing in minimally invasive treatments for vascular disease.

We are fast-paced and team-oriented focused on delivering efficient, high-quality patient care while creating growth opportunities for our employees.

We are currently seeking a detail oriented, intelligent, and experienced Credentialing Manager.

Position Summary:

Vascular Centers of America is seeking an experienced Credentialing Manager to oversee provider credentialing, recredentialing, and payer enrollment operations across a growing multi-state healthcare organization. This role leads the credentialing team, ensures compliance with regulatory and payer requirements, and supports efficient provider onboarding and enrollment.

Serving as the department's subject matter expert, the Credentialing Supervisor provides guidance on complex credentialing and enrollment matters, improves workflows, maintains provider data integrity, and ensures providers are credentialed and enrolled in a timely manner.

This position oversees a team of three credentialing professionals and requires a hands-on leader who actively performs credentialing and enrollment functions while providing guidance, support, and oversight to the team. The ideal candidate thrives in a fast-paced healthcare environment and is committed to accuracy, compliance, and exceptional service.

Responsibilities:

• Supervise, train, and support credentialing specialists.

• Oversee the credentialing and recredentialing of physicians and nurse practitioners.

• Manage provider enrollment, revalidation, and maintenance with Medicare, Medicaid, and commercial insurance carriers.

• Serve as the primary escalation point for complex credentialing and payer enrollment issues.

• Resolve enrollment delays, application denials, and participation issues.

• Ensure credentialing files and applications are complete, accurate, and compliant.

• Coordinate provider additions, terminations, and demographic updates.

• Monitor provider licenses, DEA registrations, board certifications, malpractice insurance, and other required credentials.

• Ensure timely renewals to prevent interruptions in provider participation.

• Maintain compliance with organizational policies, payer requirements, CMS regulations, NCQA standards, and state licensing requirements.

• Maintain accurate and current provider information within credentialing databases.

• Build and maintain relationships with insurance carrier representatives.

• Educate providers regarding credentialing requirements and enrollment processes.

• Communicate application status and expected enrollment timelines.

• Assist providers with licensing, CAQH maintenance, and documentation requirements.

• Identify workflow improvements and implement best practices for the credentialing department.

• Maintain credentialing policies, procedures, and department documentation.

• Assist with internal and external audits.

• Participate in departmental quality initiatives and compliance projects.

Requirements:

• Minimum of 5 years of healthcare credentialing experience required.

• Minimum of 2 years of supervisory or leadership experience required.

• Extensive knowledge of provider credentialing, recredentialing, and payer enrollment processes required.

• Experience with Medicare, Medicaid, and commercial payer enrollment required.

• Experience managing complex provider enrollment issues, application denials, and payer escalations required.

• Experience working in physician practices, ambulatory healthcare organizations, or similar healthcare settings.

• Strong understanding of CMS, NCQA, Joint Commission, and state regulatory requirements.

• Experience with CAQH, PECOS, NPPES, and payer credentialing portals.

• Experience with credentialing software and electronic document management systems.

• Strong organizational, project management, analytical, and problem-solving skills.

• Ability to manage multiple priorities and deadlines in a fast-paced environment.

• Excellent written, verbal, and interpersonal communication skills.

• Proficiency in Microsoft Office Suite, including Excel.

• Ability to lead, mentor, and develop credentialing team members while actively managing credentialing and enrollment responsibilities.

• Certified Provider Credentialing Specialist (CPCS) and/or Certified Professional Medical Services Management (CPMSM) certification preferred.

• Bachelor's degree in Healthcare Administration, Business Administration, or related field preferred.

If you are an experienced and detail oriented credentialing professional who enjoys both leadership and hands-on credentialing work, we encourage you to apply and join our growing team!