Credentialing Program Manager

Job Description

Job Description

Description:

Position Summary:

The Credentialing Program Manager is responsible for the overall administration, execution, and continuous improvement of Agile Occupational Medicine's provider credentialing and enrollment program. This role ensures that all providers maintain current credentials, licenses, certifications, payer enrollments, and regulatory requirements necessary to practice across Agile's clinics and service lines.

The Credentialing Program Manager serves as the subject matter expert for provider credentialing and enrollment, partnering closely with Talent Acquisition, Medical Leadership, Operations, Revenue Cycle, Compliance, Sales and external payers to ensure providers are credentialed, enrolled, and ready to practice in a timely manner.

This position oversees the full credentialing lifecycle, including initial credentialing, recredentialing, payer enrollment, committee administration, compliance monitoring, and process improvement initiatives.

Essential Duties and Responsibilities:

Provider Credentialing & Enrollment

• Manage the end-to-end credentialing process for all newly hired providers, ensuring timely completion prior to start dates.
• Coordinate and validate provider applications, licenses, certifications, DEA registrations, board certifications, education, training, work history, malpractice coverage, and other required documentation.
• Oversee payer enrollment and provider enrollment activities to ensure providers are appropriately contracted and billable.
• Maintain provider credentialing records and databases, ensuring accuracy and compliance with organizational, payer, state, federal, and accreditation requirements.
• Monitor credentialing timelines and proactively address delays that could impact provider onboarding or revenue cycle performance.

Recredentialing & Compliance

• Manage annual and periodic recredentialing processes for all providers.
• Track and monitor license renewals, certifications, DEA registrations, malpractice coverage, and other required credentials.
• Conduct ongoing monitoring of sanctions, exclusions, disciplinary actions, and regulatory compliance requirements.
• Ensure provider files remain audit-ready and compliant at all times.
• Credentialing Committee Management
• Serve as administrator and coordinator for the Credentialing Committee.
• Prepare credentialing packets, committee agendas, and supporting documentation.
• Facilitate committee meetings and maintain meeting minutes and credentialing records.
• Track committee decisions and ensure timely communication and implementation of approvals or actions.

Talent Acquisition Partnership

• Partner closely with Talent Acquisition to support provider recruitment and onboarding efforts.
• Provide credentialing guidance during the recruiting process to identify potential licensing, enrollment, or credentialing barriers.
• Establish credentialing timelines for new provider hires and communicate progress to hiring managers and leadership.
• Support provider onboarding initiatives to improve time-to-productivity and readiness to practice.

Program Leadership & Process Improvement

• Develop, implement, and maintain credentialing policies, procedures, and best practices.
• Identify opportunities to improve credentialing efficiency, provider onboarding timelines, and payer enrollment processes.
• Create and maintain reporting and key performance indicators related to credentialing, enrollment, and provider readiness.
• Serve as the primary point of contact for credentialing-related audits, surveys, and regulatory reviews.
• Partner with operational and medical leadership to support organizational growth initiatives, acquisitions, and new clinic openings.

Education & Experience

• Bachelor's degree preferred; equivalent combination of education and experience may be considered.
• Minimum 5 years of healthcare credentialing experience required.
• Minimum 2 years managing or leading credentialing programs preferred.
• Experience with provider credentialing, payer enrollment, medical staff credentialing, and healthcare regulatory requirements.
• Experience supporting multi-site healthcare organizations preferred.

Knowledge, Skills & Abilities

• Strong understanding of credentialing standards, payer enrollment requirements, CAQH, PECOS, Medicare, Medicaid, and commercial payer processes.
• Knowledge of Joint Commission, NCQA, URAC, and applicable regulatory standards.
• Strong project management and organizational skills.
• Excellent attention to detail and ability to manage multiple priorities simultaneously.
• Ability to build effective partnerships across Talent Acquisition, Medical Leadership, Operations, Revenue Cycle, and Compliance.
• Strong communication, problem-solving, and analytical skills.
• Proficiency with credentialing software, provider databases, and Microsoft Office applications.