Credentialing Manager

Job Number: 26-12938

Job Summary: The Credentialing Manager oversees the daily operations and administration of the Credentialing Department, ensuring providers are credentialed and enrolled in compliance with national, state, local, accreditation, and departmental standards. This role manages provider credentialing, re-credentialing, enrollment, audits, reporting, and database administration through the symplr Provider (CACTUS) system for internal, contracted, and external provider networks.

Responsibilities include supervising credentialing and provider enrollment staff; coordinating credentialing committee processes; maintaining credentialing policies and procedures; ensuring primary source verification of licenses, certifications, insurance, sanctions, and background checks; and managing provider electronic files and records. The Credentialing Manager also oversees provider enrollment with Medicaid, Medicare, and commercial health plans, monitors compliance requirements, develops operational reports, supports audits, and resolves credentialing issues in a timely and professional manner.

This position serves as a key liaison with providers, staff, health plans, and external partners while promoting high-quality customer service and implementing processes that improve employee and contractor experiences.

Essential duties and job responsibilities:

• Manage credentialing, re-credentialing, and provider enrollment activities for internal, external, and contracted providers.
• Supervise credentialing and provider enrollment staff and department operations.
• Administer and maintain the symplr Provider (CACTUS) credentialing database and provider e-files.
• Coordinate Credentialing Committee activities and ensure compliance with regulatory and accreditation standards.
• Monitor provider licensure, sanctions, certifications, insurance, and other compliance requirements.
• Prepare audits, reports, budgets, and departmental expenditures.
• Collaborate with providers, payors, staff, and community partners to support efficient credentialing operations and exceptional customer service.

Regular, predictable attendance is considered to be an essential requirement for this position. Other duties may be assigned. May require a flexible work schedule.

Integral Care employees are to strive to maintain a trauma sensitive workplace, to embrace trauma sensitive and informed practices, and to foster a supportive and welcoming environment of care.

Education:

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field as required

License:

Required:

• Current and valid driver's license and a clean driving record.

Experience:

• Four years of progressive credentialing or related administrative experience required.
• One to two years of healthcare or behavioral healthcare background with knowledge of managed care and network development, provider relation activities or healthcare delivery system preferred.
• Two years of progressively responsible administrative experience desirable, with demonstrated ability to handle sensitive and highly confidential information.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification preferred. If not certified currently, ability to obtain certification is required.
• Experience with employee supervision and department management preferred.
• Experience and proficiency with web-based credentialing applications and database software required.
• Experience with symplr PROVIDER (CACTUS) credentialing software highly preferred.

Hours: Full-Time.

Workdays: Monday - Friday.

Workhours: 8:00AM - 5:00PM.

Salary: $81,912.81 annually.

Employee Benefits:

• Medical, Dental, and Vision insurance
• Generous vacation/holiday/sick leave
• Life and Short-term/Long-term Disability Insurance
• Employee Assistance Program (EAP)
• 403(b) retirement account
• Gold's Gym membership discount
• Mileage reimbursement

For specific positions, additional compensation may be offered to candidates who are bilingual in English and another language deemed necessary for the role.