Clinical Credentialing Manager

Position Summary:

The Clinical Credentialing Manager is responsible for overseeing the credentialing, privileging, and re-credentialing processes for all clinical staff. This role ensures compliance with regulatory standards, payer requirements, and internal policies. The manager works cross-functionally with Human Resources, Clinical Operations, and Billing departments to support timely provider onboarding and ongoing credentialing accuracy.

Key Responsibilities:

• Credentialing & Recredentialing:

  • Manage the full lifecycle of credentialing and recredentialing for physicians, therapists, and other licensed professionals.

  • Submit and track provider applications with insurance panels and regulatory bodies.

  • Ensure timely follow-up and resolution of any delays or discrepancies.

• Compliance & Audits:

  • Maintain up-to-date and organized credentialing files and documentation.

  • Ensure compliance with Joint Commission, NCQA, CMS, and state/federal regulations.

  • Prepare for and participate in credentialing audits or payer revalidations.

• System Management & Reporting:

  • Utilize credentialing software to manage records and generate regular status reports.

  • Track licensure expirations, board certifications, DEA registrations, malpractice insurance, and other required documents.

  • Monitor and ensure all providers maintain active credentials.

• Team Leadership & Support:

  • Supervise credentialing specialists or administrative assistants (if applicable).

  • Train and guide team members on credentialing best practices and updates.

  • Serve as a subject matter expert and resource to clinical staff regarding credentialing.

• Relationship Management:

  • Liaise with payers, licensing boards, and healthcare entities to facilitate timely credentialing.

  • Support the onboarding process in collaboration with HR and Clinical Management.

Qualifications:

• Bachelor’s Degree in Healthcare Administration, Business.

• Minimum 3–5 years of experience in provider credentialing, preferably in a behavioral health or multi specialty setting.

• Familiarity with CAQH, NPPES, PECOS, Medicare/Medicaid enrollment, and insurance paneling processes.

• Strong knowledge of credentialing compliance requirements and industry best practices.

• Proficiency with credentialing software and Microsoft Office Suite.

• Excellent attention to detail, communication, and organizational skills.