Credentialing Manager

Description

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.

• 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 time frames, 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 escape matters, or special projects.

• 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.

• 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.

• 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.