Job DescriptionSchedule: Days: M-FJob Location Type: RemoteThis position provides leadership to the credentialing team and ensures credentialing activities are completed accurately, timely, and in accordance with applicable regulatory, accreditation, contractual, and payer requirements. The Manager works closely with internal teams, providers, facilities, payers, and Lifepoint stakeholders to maintain effective credentialing processes and support network participation.
How you'll contribute A
Manager, Credentialing who excels in this role:
Credentialing Operations & Leadership- Provides day-to-day leadership and oversight of Gateway's credentialing team and credentialing operations.
- Establishes priorities, monitors workload and performance, and ensures credentialing activities are completed within required timelines.
- Develops and maintains standardized credentialing processes, policies, procedures, and documentation.
- Identifies opportunities to improve efficiency, consistency, and automation within credentialing operations.
- Serves as an escalation point for complex credentialing issues and works with appropriate stakeholders to resolve barriers.
Provider Credentialing & Delegation- Oversees initial credentialing and recredentialing of providers in accordance with Gateway policies, payer requirements, and applicable accreditation and regulatory standards.
- Ensures appropriate primary source verification, documentation, quality review, and presentation to the Credentialing Committee.
- Maintains compliance with delegated credentialing agreements and payer-specific requirements.
- Coordinates and supports delegated credentialing audits, corrective actions, and ongoing monitoring.
- Oversees provider roster maintenance and works with internal teams and payers to ensure accurate provider participation information.
Facility Credentialing- Leads Gateway's centralized facility credentialing and recredentialing support for designated Lifepoint facilities.
- Develops and maintains standardized processes for facility applications, recredentialing, documentation requirements, payer submissions, and follow-up.
- Maintains centralized tracking of facility credentialing activity, including payer requirements, submission dates, expiration dates, outstanding documentation, and application status.
- Coordinates with facility leadership, Managed Care, payers, and other stakeholders to obtain required information and ensure timely completion of credentialing requirements.
- Serves as a central point of contact for payer questions, application status, and escalation of facility credentialing issues.
- Supports implementation and onboarding of additional facilities as the centralized credentialing model expands.
- Identifies opportunities to improve technology, shared documentation, tracking, and automation of facility credentialing processes.
Compliance, Reporting & Performance- Monitors credentialing performance, turnaround times, upcoming deadlines, and compliance risks.
- Ensures credentialing records and supporting documentation are maintained appropriately and are audit-ready.
- Provides credentialing status updates and reporting to leadership and other stakeholders as needed.
- Maintains knowledge of applicable credentialing standards, payer requirements, and regulatory changes.
- Partners with Gateway leadership, Managed Care, Compliance, Legal, and other teams as appropriate to address credentialing requirements and operational issues.
Why join usWe believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:
- Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
- Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
- Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
- Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
- Professional Development: Ongoing learning and career advancement opportunities.
What we're looking for Education:- Bachelor's degree in healthcare administration, business administration, or a related field preferred. Equivalent combination of education and relevant experience may be considered.
Experience:- Experience in healthcare credentialing, provider enrollment, managed care, provider network operations, or a related healthcare function.
- Prior leadership or supervisory experience preferred.
- Experience with delegated credentialing, payer requirements, audits, or accreditation standards preferred - NCQA Credentialing Standards.
- Experience with facility credentialing or healthcare facility enrollment is preferred.
Knowledge, Skills & Abilities:- Strong knowledge of healthcare credentialing processes and requirements.
- Strong organizational and project management skills with the ability to manage multiple priorities and deadlines.
- Ability to develop and implement standardized operational processes.
- Strong attention to detail and commitment to accuracy and compliance.
- Effective written and verbal communication skills.
- Ability to collaborate with providers, facility leaders, payers, and internal stakeholders.
- Ability to identify operational issues, escalate risks appropriately, and drive issues to resolution.
- Proficiency with Microsoft Office applications and credentialing/tracking systems.
- Up to 10% travel may be required.
