Credentialing Manager

Job Description

Job Description

Description:

Position Overview

The Credentialing Manager is a working manager responsible for overseeing provider credentialing, recredentialing, and payor enrollment activities for Children’s Specialized ABA. This position leads and supports credentialing staff, ensures timely and accurate outcomes, monitors departmental performance, and maintains compliance with payor, regulatory, contractual, and organizational requirements.

In addition to overseeing the department, the Credentialing Manager maintains an assigned low volume credentialing workload. The manager also remains sufficiently knowledgeable and engaged in credentialing workflows to provide broader direct coverage during staff PTO, vacancies, high-volume periods, urgent matters, and special projects.

Essential Duties and Responsibilities

Credentialing and Enrollment Operations

• Oversee the full provider credentialing and payor enrollment lifecycle, including initial credentialing, recredentialing, renewals, demographic updates, group and practice-location linkages, provider additions, and terminations.
• Ensure credentialing staff complete applications and supporting documentation accurately, submit them within required timeframes, and follow them through final payor approval, effective-date confirmation, and system loading.
• Monitor departmental workflows, provider files, pending applications, expiring credentials, and enrollment risks to ensure timely follow-up, escalation, and resolution.
• Ensure provider information is maintained accurately across internal systems, CAQH, NPPES, Medicaid systems, and commercial payor portals.
• Ensure credentialing records are complete, confidential, organized, compliant, and audit-ready.
• Provide direct credentialing support when needed for staff coverage, high-volume periods, urgent or escalate matters, or special projects.

Assigned Credentialing Responsibilities

• Directly manage all initial credentialing, recredentialing, enrollment, and ongoing maintenance for non-New Jersey master’s-level and above providers.
• Own provider roster completion, maintenance, validation, submission, tracking, correction, and final payor confirmation.
• Own payor practice-location additions, updates, tracking, follow-up, and confirmation.
• Maintain visibility into the status, deadlines, risks, and outcomes of all assigned submissions.
• Ensure provider, location, address, tax entity, group affiliation, and enrollment information is accurate across payor portals and internal systems.
• Ensure credentialing-related payor portals remain accessible, current, and assigned to appropriate staff.
• Balance assigned credentialing responsibilities with departmental leadership, staff oversight, and operational priorities.

Staff Leadership and Department Performance

• Supervise, coach, train, and support credentialing staff on expectations for productivity, accuracy, timeliness, follow-up, documentation, and escalation.
• Assign and balance workloads based on volume, complexity, organizational priorities, and staff capacity.
• Review staff work, address performance or quality concerns, and participate in hiring, onboarding, performance evaluations, and corrective action processes.
• Monitor and report departmental KPIs, including application volume, aging, turnaround times, accuracy, pending items, recredentialing completion, roster status, and confirmed enrollment outcomes.
• Identify workflow gaps, recurring errors, backlogs, and staffing or training needs and recommend sustainable solutions.

Cross-Functional Collaboration and Coverage

• Collaborate with internal stakeholders as needed for projects, operational updates, and sufficient flow of information.
• Communicate credentialing risks or delays that may affect provider onboarding, case assignment, authorization processing, claims submission, payment, or revenue.
• Establish clear handoffs and communication processes so downstream teams receive the credentialing information needed to perform their responsibilities.
• Provide additional hands-on departmental coverage when necessary, which may include application tracking, data entry, portal updates, provider or payor communication, and issue resolution.

Compliance and Process Improvement

• Ensure credentialing activities comply with applicable payor requirements, federal and state regulations, accreditation standards, delegated credentialing requirements, contracts, and organizational policies.
• Maintain standardized policies, procedures, checklists, trackers, quality controls, and escalation processes.
• Conduct routine audits of provider files, applications, rosters, payor systems, and staff documentation.
• Ensure required licensure, certification, sanction, exclusion, and other ongoing monitoring activities are completed and documented.
• Monitor changes in credentialing requirements and update departmental processes and staff training accordingly.
• Support credentialing implementation for new payors, states, entities, service lines, and practice locations.

Minimum Qualifications

Education

• High school diploma or GED. 

Experience 

• 5+ years of experience provider credentialing required.
• 2+ years of management, supervisory or team-lead experience required.
• Comprehensive provider credentialing and enrollment experience, including roster and practice-location management, provider data systems, primary-source verification, and ongoing compliance monitoring.
• Experience managing credentialing operations across multiple payors, states, entities, and locations.
• Experience managing an assigned workload while overseeing staff and departmental performance required.
• Experience supporting behavioral health, applied behavior analysis, therapy, or NCQA-aligned credentialing operations preferred. 

Skills

• Strong leadership, communication, organization, and problem-solving skills, with the ability to manage competing priorities in a fast-paced environment.
• Demonstrated ability to work independently and collaboratively across teams with a high degree of ownership, accountability, and sound judgment.
• Highly detail-oriented, adaptable, and professional, with a commitment to accuracy, confidentiality, and practical solutions. 

Technical Proficiency  

• Proficiency in Microsoft Office (Outlook, Excel)
• Ability to quickly learn and navigate multiple payor portals and EHR/practice management systems

Background Check 

• Must pass upon hire. 

Physical Requirements

• Prolonged periods of sitting and computer use.

Here’s what you can expect:

• Up to 19 paid days off in your first year (including PTO, sick time, and holidays); earned on an accrual basis, paid time off increases with tenure
• Comprehensive benefits including FREE medical (for employee, buy-up for dependent/partner coverage), voluntary dental, vision, short-term disability, critical illness coverage, and more!
• Free 50k life insurance policy.
• Free Employee Assistance Program (EAP).
• 401(k) retirement savings plan
• Company discount program – discounts of amusement parks, memberships, cruises, movie tickets, spas, sports ticks and more.

Requirements: