The Credentialing Manager oversees the end-to-end credentialing process, ensuring all providers are properly credentialed and compliant with regulatory requirements and internal standards. This role is responsible for leading credentialing operations, verifying documentation, and managing provider enrollment while driving process improvements and supporting team performance. The Credentialing Manager plays a key role in maintaining efficient workflows and ensuring seamless operations.

Duties and Responsibilities

Ø Oversees all credentialing activities to ensure effective operations, regulatory compliance, and that all providers are properly credentialed in accordance with government and state requirements

Ø Leads the completion of initial and re-credentialing applications, ensuring accuracy, timeliness, and inclusion of all required supporting documentation

Ø Identifies complex issues requiring further investigation, validates discrepancies, and ensures appropriate resolution and follow-up by the team

Ø Oversees the processing of privileging requests, ensuring accuracy and adherence to organizational standards

Ø Serves as a key point of contact for internal and external stakeholders, addressing credentialing and privileging inquiries and escalating issues as needed

Ø Monitors initial credentialing, reappointments, and expirable items for all providers to ensure ongoing compliance with regulatory bodies

Ø Reviews and approves provider applications and supporting documentation to ensure eligibility and completeness

Ø Oversees the preparation and presentation of credentialing files for committee review and final approval

Ø Manages credentialing operations by ensuring proper collection, verification, and documentation of provider data in accordance with policies and audit standards

Ø Directs daily workflow, assigns responsibilities, and establishes team priorities to meet deadlines and operational goals

Ø Supports contract acquisition efforts and ensures appropriate follow-up and coordination with relevant stakeholders

Ø Provides leadership in issue escalation and resolution, fostering clear communication and effective problem-solving across the team

Ø Ensures all follow-up activities are completed proactively and within established timelines

Ø Performs additional leadership and operational duties as needed to support departmental and organizational objectives

Qualifications

License/Certification: None required

Education: High School or equivalent

Experience: Six years business office experience, equivalent education of combination of education and experience.

Critical Skills:

• Customer service
• Multi-tasking
• Time management
• Organization and attention to detail
• Ability to work under pressure
• Calming manner
• Discretion while maintaining patient confidentiality
• Problem-solving skills
• Good communication and interpersonal skills
• Thorough knowledge of medical terminology and human anatomy
• Able to escalate or resolve patient issues as necessary - communicate immediately with your supervisory physician regarding patient satisfaction issues that you cannot resolve or situations that affect your ability to perform your job duties.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.