Credentialing Manager

Job Description

Job Description

Manager of Credentialing (Healthcare)

Location: Remote (US) or Hybrid (City, State)
Type: Full-time
Reports to: Head of Operations / Director of Provider Operations (or similar)
Comp: Competitive base + equity + benefits

About the Company

Our client is a venture-backed healthcare startup building a modern platform that makes it easier for patients to access high-quality care and for clinicians to practice at the top of their license. The team is scaling quickly, operating in multiple states, and credentialing is core to the ability to grow safely and compliantly.

The Role

Our client is hiring a Manager of Credentialing to own and scale the credentialing function. You’ll lead day-to-day credentialing operations, build repeatable systems, and partner cross-functionally with Operations, Clinical, Legal/Compliance, and Product to reduce time-to-credential while maintaining rigorous quality standards.

This is a high-ownership role for someone who can execute in the details and improve the system.

What You’ll Do

• Own end-to-end credentialing for clinicians/providers across multiple states and payers (as applicable), including new credentialing, recredentialing, and ongoing maintenance.

• Manage a small team and/or vendors (CVOs) and drive clear KPIs (time-to-credential, first-pass yield, aging, rework rate).

• Create and maintain SOPs, checklists, and QA processes to ensure accuracy, completeness, and audit readiness.

• Partner with Provider Operations to forecast pipeline needs and proactively manage throughput/capacity.

• Serve as escalation point for complex cases (sanctions queries, gaps in work history, adverse actions, board issues, expiring coverage, etc.).

• Build strong relationships with hospitals/health systems, payers, state boards, CAQH, and third-party credentialing partners.

• Maintain credentialing files and documentation standards (primary source verification, attestations, NPDB queries where applicable, licensure, DEA, malpractice, education, references).

• Collaborate with Compliance/Legal to ensure adherence to NCQA/URAC standards where required and internal policies.

• Work with Product/Engineering to improve tooling: workflow automation, document collection, status transparency, integrations (CAQH, NPPES, PECOS, etc.), and reporting.

• Lead continuous improvement initiatives that reduce cycle time and increase reliability as we scale.

What We’re Looking For

• 5+ years in provider credentialing and/or provider enrollment operations, including 1–3+ years in a lead/manager capacity.

• Deep familiarity with credentialing best practices (primary source verification, file auditing, recredentialing cadence, documentation standards).

• Experience working with CAQH and common verification sources (state boards, OIG/SAM exclusions, NPDB where applicable, malpractice carriers, education verification).

• Track record building processes in a fast-moving environment (startup, high-growth healthcare org, or building a new function).

• Strong operational rigor: you can manage multiple queues, deadlines, and stakeholders without dropping details.

• Comfort with ambiguity and ownership—able to diagnose problems, propose fixes, and implement improvements.

• Excellent written and verbal communication; able to work cross-functionally and manage escalations calmly.

• Proficiency with tools like Google Workspace/Excel; experience with credentialing platforms (e.g., Modio, symplr, VeraSuite, Medallion, or similar) is a plus.

Nice to Have

• Experience credentialing across multiple specialties and state footprints.

• Familiarity with NCQA/URAC standards and audits.

• Experience with payer enrollment (commercial, Medicare/Medicaid) or delegated credentialing.

• Prior experience managing a CVO relationship and negotiating SLAs.

• Product-minded operator who’s helped implement or improve credentialing software/workflows.

Why Join

• Meaningful mission with direct impact on patient access and provider experience.

• Opportunity to build and own a critical function at a high-growth, venture-backed company.

• Competitive compensation, equity upside, and benefits.

• High-trust environment with autonomy and room to grow.