Manager, Credentialing

Description

Schedule: Days: M-F

Job Location Type: Remote

Your experience matters

At Lifepoint Health we are committed to empowering and supporting a diverse and determined workforce who can drive quality scalability and significant impact across our hospitals and communities. As a member of the Health Support Center (HSC) team youll support those that are in our facilities who are interfacing and providing care to our patients and community members to positively impact our mission of making communities healthier .

More about our team

This position provides leadership to the credentialing team and ensures credentialing activities are completed accurately timely and in accordance with applicable regulatory accreditation contractual and payer requirements. The Manager works closely with internal teams providers facilities payers and Lifepoint stakeholders to maintain effective credentialing processes and support network participation.

How youll contribute

A Manager Credentialing who excels in this role:

Credentialing Operations & Leadership

• Provides day-to-day leadership and oversight of Gateways credentialing team and credentialing operations.
• Establishes priorities monitors workload and performance and ensures credentialing activities are completed within required timelines.
• Develops and maintains standardized credentialing processes policies procedures and documentation.
• Identifies opportunities to improve efficiency consistency and automation within credentialing operations.
• Serves as an escalation point for complex credentialing issues and works with appropriate stakeholders to resolve barriers.

Provider Credentialing & Delegation

• Oversees initial credentialing and recredentialing of providers in accordance with Gateway policies payer requirements and applicable accreditation and regulatory standards.
• Ensures appropriate primary source verification documentation quality review and presentation to the Credentialing Committee.
• Maintains compliance with delegated credentialing agreements and payer-specific requirements.
• Coordinates and supports delegated credentialing audits corrective actions and ongoing monitoring.
• Oversees provider roster maintenance and works with internal teams and payers to ensure accurate provider participation information.

Facility Credentialing

• Leads Gateways centralized facility credentialing and recredentialing support for designated Lifepoint facilities.
• Develops and maintains standardized processes for facility applications recredentialing documentation requirements payer submissions and follow-up.
• Maintains centralized tracking of facility credentialing activity including payer requirements submission dates expiration dates outstanding documentation and application status.
• Coordinates with facility leadership Managed Care payers and other stakeholders to obtain required information and ensure timely completion of credentialing requirements.
• Serves as a central point of contact for payer questions application status and escalation of facility credentialing issues.
• Supports implementation and onboarding of additional facilities as the centralized credentialing model expands.
• Identifies opportunities to improve technology shared documentation tracking and automation of facility credentialing processes.

Compliance Reporting & Performance

• Monitors credentialing performance turnaround times upcoming deadlines and compliance risks.
• Ensures credentialing records and supporting documentation are maintained appropriately and are audit-ready.
• Provides credentialing status updates and reporting to leadership and other stakeholders as needed.
• Maintains knowledge of applicable credentialing standards payer requirements and regulatory changes.
• Partners with Gateway leadership Managed Care Compliance Legal and other teams as appropriate to address credentialing requirements and operational issues.

Why join us

We believe that investing in our employees is the first step to providing excellent patient addition to your base compensation this position also offers:

• Comprehensive Benefits :Multiple levels of medical dental and vision coverage for full-time andpart-time employees.

• Financial Protection & PTO : Life accident critical illness hospital indemnity insurance short- and long-term disability paid family leave and paid time off.

• Financial & Career Growth : Higher education and certification tuition assistance loan assistance and 401(k) retirement package and company match.

• Employee Well-being : Mental physical and financial wellness programs (free gym memberships virtual care appointments mental health services and discount programs).

• Professional Development :Ongoing learning and career advancement opportunities.

What were looking for

Education:

• Bachelors degree in healthcare administration business administration or a related field preferred. Equivalent combination of education and relevant experience may be considered.

Experience:

• Experience in healthcare credentialing provider enrollment managed care provider network operations or a related healthcare function.
• Prior leadership or supervisory experience preferred.
• Experience with delegated credentialing payer requirements audits or accreditation standards preferred NCQA Credentialing Standards .
• Experience with facility credentialing or healthcare facility enrollment is preferred.

Knowledge Skills & Abilities:

• Strong knowledge of healthcare credentialing processes and requirements.
• Strong organizational and project management skills with the ability to manage multiple priorities and deadlines.
• Ability to develop and implement standardized operational processes.
• Strong attention to detail and commitment to accuracy and compliance.
• Effective written and verbal communication skills.
• Ability to collaborate with providers facility leaders payers and internal stakeholders.
• Ability to identify operational issues escalate risks appropriately and drive issues to resolution.
• Proficiency with Microsoft Office applications and credentialing/tracking systems.
• Up to 10% travel may be required.

EEOC Statement

Lifepoint Health is an Equal Opportunity Employer. Lifepoint Health is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

You must be authorized to work in the United States without employer sponsorship.

Required Experience:

Manager