Credentialing Manager

Responsibilities

• Oversee all provider credentialing, recredentialing, payer enrollment, and provider maintenance activities for ISBH
• Manage the credentialing team and coordinate daily workflow to ensure the timely completion of credentialing activities
• Responsible for performance management, recruitment, onboarding, and team development, including but not limited to implementing progressive discipline when necessary
• Ensure timely submission, tracking, and follow-up of credentialing and recredentialing applications to prevent lapses in provider participation
• Maintain provider credentialing files and databases, ensuring all licenses, certifications, registrations, and other required documentation remain current.
• Monitor provider enrollment status with Ohio Medicaid, Medicare, commercial payers, and other contracted entities
• Serve as the primary resource for resolving complex credentialing and payer enrollment issues
• Ensure compliance with federal, state, accreditation, and payer‑specific credentialing requirements
• Develop, implement, and maintain credentialing policies, procedures, and quality assurance standards
• Monitor credentialing performance metrics and identify opportunities for process improvement and operational efficiency
• Collaborate with billing, compliance, human resources, clinical leadership, and provider relations teams to support organizational goals
• Maintain expertise in credentialing regulations, payer requirements, provider enrollment processes, and industry best practices
• Coordinate credentialing activities related to new programs, services, locations, and revenue streams
• Participate in audits, accreditation reviews, and compliance activities as required
• Attend virtual and in‑person internal and external training, conferences, and meetings as appropriate
• Maintain compliance with HIPAA, mandated reporting requirements, and professional ethical guidelines
• Travel within the designated service area
• Perform other duties as assigned

• A high school diploma or GED equivalent is required
• A bachelor's degree in business, Public Health, Healthcare Administration, or a related field is preferred
• 5 years of experience in provider credentialing and payer enrollment in a healthcare setting is required
• 3 years of supervisory or management experience in a healthcare credentialing role is required
• Experience with Ohio Medicaid provider enrollment and credentialing is required
• Experience working with credentialing systems and electronic health records is required
• Experience utilizing NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals is required
• Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance
• Ability to manage multiple projects, deadlines, and priorities independently
• Advanced analytical, organizational, and problem‑solving skills
• Proficiency with databases, spreadsheets, and Microsoft Office applications
• Advanced communication skills, both oral and written is required
• Advanced organizational skills are required
• Knowledge of local, state, and federal regulations is required
• The ability to maintain confidential information is required
• Ability to adhere to all safety rules, regulations, and requirements
• A valid driver's license and the ability to operate a motor vehicle are required
• An appropriate level of auto insurance coverage is required
• Ability to manage deadlines within a fast‑paced, high‑volume environment is required
• The ability to operate in an Internet‑based, automated office environment is required
• The ability to maintain a high‑speed internet connection is required.