Credentialing Manager

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