Credentialing Manager

Who We Are

Twelve Stone Health Partners is focused on the medication needs of patients with chronic, complex and rare conditions. For more than 35 years, Twelve Stone Health has been dedicated to finding new ways to deliver care designed around the patient. Chronic conditions include Multiple Sclerosis, NMOSD, Myasthenia Gravis, CIDP, ITP, Migraine Prevention, Crohn’s Disease, Ulcerative Colitis, Plaque Psoriasis, Alpha 1 Antitrypsin Deficiency, Primary Immunodeficiency, hATTR Amyloidosis, Thyroid Eye Disease, and many others.

For patients, we provide access to the most advanced medications, along with the personal and financial support patients need to live with chronic conditions. For providers, we simplify treatment for complex conditions by eliminating the administrative and clinical burdens placed on your practice when patients need innovative specialty medications. Twelve Stone Health Partners supports the transition from acute to post-acute care environments and the journey from sickness to health.

We are currently licensed in 50 states.

We are currently hiring for the position of Credentialing Manager. The Credentialing Manager is responsible for overseeing provider and facility credentialing and enrollment activities across multiple states and payors, including all individual practitioners, infusion centers and home infusion therapy contracts. This role provides leadership, quality control, and accountability for credentialing operations, ensuring timely, accurate, and compliant enrollment of providers, infusion centers, and pharmacies.

The Credentialing Manager directly oversees credentialing staff and serves as the subject matter expert for payor, CMS, and State Medicaid enrollment requirements.

• Oversee end-to-end credentialing and enrollment processes for providers and facilities across 6+ states and 40+ locations
• Ensure timely and accurate submission, follow-up, and completion of all credentialing, recredentialing, revalidation, and enrollment activities
• Establish and enforce verification standards to confirm active enrollment with payors, CMS, and State Medicaid

• Serve as the subject matter expert for payor-specific credentialing and enrollment requirements, including Availity, PECOS, CAQH, and state Medicaid portals
• Interpret and apply payor rules related to new providers, new locations, change-of-information submissions, and roster management
• Maintain current knowledge of CMS and state regulatory requirements

• Perform regular audits of credentialing records, payor portals, and enrollment statuses
• Identify gaps, discrepancies, or missed enrollments and implement corrective actions
• Prevent credentialing lapses that could impact reimbursement or authorization

• Indirectly manage and mentor Credentialing Specialist(s) by providing functional leadership, mentoring, and day-to-day direction, including workflow prioritization and quality oversight
• Set performance expectations, timelines, and quality standards
• Provide guidance on complex or escalated credentialing issues
• Reduce dependency on leadership for day-to-day decision-making

• Develop and maintain standardized workflows, checklists, and tracking tools by payor and state
• Improve tracking systems to ensure visibility and accountability
• Partner with Compliance, Contracting, Revenue Cycle, and Operations to align credentialing with organizational growth

• Serve as the primary escalation point for internal departments and payors regarding credentialing issues
• Maintain clear communication with leadership on risks, timelines, and capacity needs
• Support growth initiatives by proactively planning credentialing needs for new locations and providers

Other duties as assigned

Education: Associate degree required

Experience: 5-7+ years of healthcare credentialing and enrollment experience, demonstrated proficiency with Availity, PECOS, CAQH, and State Medicaid enrollment systems, experience managing multi-state provider and facility credentialing at scale, prior people management or lead experience required, experience in infusion, specialty pharmacy, or complex healthcare environments preferred.

Confidentiality: Maintains strict confidentiality regarding protected health information and understands and adheres to HIPAA Privacy & Security policies and procedures. Maintains strict confidentiality regarding provider and practice information.

Functional

Competencies:

Strong attention to detail with ability to see both operational details and broader impacts, critical thinking, prioritization, problem solving, approachable, dependable, verbal, and written communication, teamwork, cooperation, collaboration, judgment.