Credentialing and Regulatory Operations Manager

Circle Medical; United States; On-site; USD 73,000 - 81,000; Full time

Benefits offered by this job

Paid Time Off

Health & Insurance

Wellness programs

Retirement plan with company match

Professional development reimbursement

Job summary

Circle Medical is a virtual-first primary care organization hiring a Credentialing and Regulatory Operations Manager in the United States. You will lead provider credentialing, licensing, and privileging programs, manage staff, and ensure compliance with CMS, NCQA, and payer requirements while coordinating with Compliance and Legal teams.

You will oversee workflows, drive accuracy, maintain supervising physician agreements, and optimize operational metrics across credentialing cycles, renewals,

Qualifications

• Bachelor’s degree in healthcare administration, business administration, or related field.
• 3+ years of progressive provider credentialing, licensing, or medical staff services experience.
• 2+ years of supervisory or management experience.
• In-depth knowledge of NCQA, Joint Commission, CMS credentialing standards.
• Strong leadership and communication skills.
• Proficiency in credentialing software and Google applications.

Responsibilities

• Own end-to-end credentialing, re-credentialing, supervising physician management, privileging, and licensing.
• Ensure compliance with CMS, NCQA, Joint Commission, and payer requirements.
• Manage primary source verification of education, training, licensure, board certification, DEA, sanctions, and work history.
• Maintain supervising physician relationships and agreements.
• Collaborate with Compliance, Legal, Revenue Cycle, Provider Operations, and Clinical Leadership.
• Coordinate credentialing information for payer enrollment, revalidation, and re-credentialing.

Skills

Provider credentialing

Licensing requirements

Leadership & supervision

Communication

Regulatory compliance

Data accuracy

Google applications

Education

Bachelor’s degree in healthcare administration or related field

CPCS or CPMSM certification

Tools

Modio

Symplr

Helix

Job description

About UsWe are a virtual-first primary care organization reimagining how people access and experience healthcare. Our mission is to deliver comprehensive, high-quality, and compassionate care that integrates technology, data, and human connection through a seamless digital platform complemented by in-person visits when needed. While our care is provided exclusively to patients in the United States, our team is distributed across the United States and Canada, bringing together clinicians, technologists, and operators who share a commitment to making high-quality healthcare delightful, personal, and accessible to everyone.

About UsWe are a virtual-first primary care organization reimagining how people access and experience healthcare. Our mission is to deliver comprehensive, high-quality, and compassionate care that integrates technology, data, and human connection through a seamless digital platform complemented by in-person visits when needed. While our care is provided exclusively to patients in the United States, our team is distributed across the United States and Canada, bringing together clinicians, technologists, and operators who share a commitment to making high-quality healthcare delightful, personal, and accessible to everyone.DescriptionThe Credentialing and Regulatory Operations Manager is responsible for overseeing all provider credentialing, licensing, privileging and supervising physician management to ensure compliance with federal, state, regulatory, accreditation, and payer requirements. This role leads credentialing operations, manages staff and workflows, oversees the supervising physician program and ensures timely, accurate processing of provider credentials to support organizational and patient care needs.ResponsibilitiesCredentialing & Licensing Operations

• Own the end-to-end strategy and execution of provider credentialing, re-credentialing, supervising physician management, privileging, and licensing at scale
• Ensure compliance with CMS, NCQA, Joint Commission, state licensing boards, and payer-specific requirements
• Oversee primary source verification including education, training, licensure, board certification, DEA, sanctions, and work history, with clear quality controls
• Oversee the ongoing maintenance of supervising/collaborating physician relationships and agreements
• Serve as primary liaison with providers, supervising physicians, clinical leadership, regulatory agencies, and internal departments
• Partner closely with Compliance, Legal, Revenue Cycle, Provider Operations, and Clinical Leadership to align credentialing timelines with onboarding, payer enrollment, and go-live readiness.
• Coordinate credentialing information required for payer enrollment, revalidation, and re-credentialing

Regulatory & Quality Assurance

• Develop, implement, and maintain credentialing policies, procedures, and workflows
• Conduct internal audits to ensure accuracy, completeness, and regulatory compliance
• Prepare for and participate in accreditation surveys, audits, and regulatory reviews
• Stay current on changes in credentialing regulations, accreditation standards, and payer requirements
• Maintain accurate supervising physician agreements and related documentation

Leadership & Team Management

• Lead, coach, and develop direct reports, setting clear performance expectations and quality standards
• Design and optimize team workflows to improve turnaround times, scalability, and accuracy
• Serve as a subject matter expert and escalation point for complex credentialing and supervising physician operational issues
• Escalate credentialing, licensing, supervision, or compliance risks promptly to appropriate leadership

Systems & Reporting

• Own credentialing systems and tooling (e.g., Modio, Symplr, Helix or similar), ensuring data integrity and audit readiness
• Proactively manage credentialing cycles, expirations, and renewals to prevent provider downtime
• Define and monitor key operational metrics (turnaround times, aging, compliance gaps, provider readiness)
• Develop and maintain dashboards, reports, and tracking mechanisms for credentialing status, expiration dates, outstanding documentation, and compliance risks
• Produce insights and reporting that inform leadership decisions, capacity planning, and process improvements

Skills / Qualifications Required

• Bachelor’s degree in healthcare administration, business administration, or related field (or equivalent experience)
• 3+ years of progressive experience in provider credentialing, licensing, or medical staff services
• 2+ years of supervisory or management experience
• In-depth knowledge of credentialing standards (NCQA, Joint Commission, CMS)
• Strong understanding of provider credentialing, privileging, and licensing requirements
• Strong leadership and team management skills
• Exceptional attention to detail and organizational abilities
• Ability to interpret complex regulations and apply them operationally
• Excellent written and verbal communication skills
• Proficiency in credentialing software and Google applications
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment

Skills / Qualifications Preferred

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)
• Experience with multi-state licensing and large provider networks
• A degree in healthcare administration or related field

CompensationOur compensation is market-aligned, performance-led, and designed to ensure internal equity. We review pay regularly, with progression tied to demonstrated impact and expanded scope rather than tenure alone. Final offers are determined by an applicant's unique skills, competencies, and qualifications.Pay Bands By Tier

• Tier 1 (San Francisco and similar cost markets): $103,770 - $115,300 base salary
• Tier 2 (Chicago and similar cost markets): $82,980 - $92,200 base salary
• Tier 3 (National, all other U.S. locations): $72,630 - $80,700 base salary

BenefitsPlease note that specific benefits vary by country and location of employment. Your recruiter will confirm the exact package available to you during the interview process.

• Paid Time Off: Flexible vacation, sick leave, and 12 statutory holidays.
• Health & Insurance: Medical, Dental, Vision, Disability, and Life insurance.
• Wellness: Mental health programs and an Employee Assistance Program (EAP).
• Retirement: RRSP/401(k) program with company match.
• Development: Annual reimbursement for eligible training and professional programs.

Applicants must be legally authorized to work in the country where the role is based at the time of application. Circle Medical is an equal opportunity employer and affirmatively seeks diversity in its workforce. Circle Medical recruits qualified applicants and advances in the employment of its employees without regard to race, color, religion, gender, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, ethnic or national origin, marital status, veteran status, or any other status protected by law. Reasonable accommodations are available— please let our Talent team know.