Credentialing Manager

Job Summary

A company is looking for a Credentialing Manager responsible for ensuring audit readiness and compliance in healthcare credentialing.

Key Responsibilities

• Manage delegation audits and serve as the primary liaison for insurance payer audits
• Implement and maintain NCQA standards and develop the Compliance Scorecard for credentialing
• Lead compliance efforts within the RCM division and oversee performance of CVO partners

Required Qualifications

• 6+ years of progressive experience in healthcare credentialing, focusing on managing delegated functions
• Proven ability to interpret complex regulatory language and translate it into operational workflows
• Deep understanding of NCQA standards and their application to credentialing
• Strong knowledge of Revenue Cycle Management and regulatory nuances in mental/behavioral health
• Exceptional organizational and project management skills for compliance projects