Credentialing Manager

Jobtailor; Piketon (OH); On-site; USD 70,000 - 110,000; Full time

Job summary

Jobtailor in Ohio is seeking a Credentialing Manager to lead provider credentialing, recredentialing, and payer enrollment for ISBH. You will direct the credentialing team, manage daily workflows, and ensure timely submissions.

The role requires a strong compliance background, experience with Ohio Medicaid, and leadership skills to drive process improvements and maintain regulatory standards.

Qualifications

• 5 years of provider credentialing and payer enrollment experience in a healthcare setting.
• 3 years of supervisory or management experience in credentialing.
• Experience with Ohio Medicaid provider enrollment and credentialing.
• Experience working with credentialing systems and electronic health records.
• Knowledge of credentialing standards and regulatory compliance.

Responsibilities

• Oversee all provider credentialing, recredentialing, payer enrollment, and provider maintenance activities.
• Manage the credentialing team and coordinate daily workflow for timely completion.
• Responsible for performance management, recruitment, onboarding, and team development.
• Ensure timely submission, tracking, and follow-up of credentialing applications.
• Maintain provider credentialing files and databases for licenses and documentation.
• Monitor enrollment status with Ohio Medicaid, Medicare, and commercial payers.
• Serve as primary resource for resolving credentialing and enrollment issues.
• Ensure compliance with credentialing requirements and QA standards.
• Develop and maintain credentialing policies and procedures.
• Monitor performance metrics and drive process improvements.

Skills

Credentialing

Payer enrollment

Supervisory experience

Regulatory compliance

EHR systems

Education

Bachelor's degree in Business / Public Health / Healthcare Administration

Tools

NPPES

CAQH

OH Medicaid PNM

Payer enrollment portals

Job description

Responsibilities

• Oversee all provider credentialing, recredentialing, payer enrollment, and provider maintenance activities for ISBH
• Manage the credentialing team and coordinate daily workflow to ensure the timely completion of credentialing activities
• Responsible for performance management, recruitment, onboarding, and team development, including but not limited to implementing progressive discipline when necessary
• Ensure timely submission, tracking, and follow-up of credentialing and recredentialing applications to prevent lapses in provider participation
• Maintain provider credentialing files and databases, ensuring all licenses, certifications, registrations, and other required documentation remain current.
• Monitor provider enrollment status with Ohio Medicaid, Medicare, commercial payers, and other contracted entities
• Serve as the primary resource for resolving complex credentialing and payer enrollment issues
• Ensure compliance with federal, state, accreditation, and payer‑specific credentialing requirements
• Develop, implement, and maintain credentialing policies, procedures, and quality assurance standards
• Monitor credentialing performance metrics and identify opportunities for process improvement and operational efficiency
• Collaborate with billing, compliance, human resources, clinical leadership, and provider relations teams to support organizational goals
• Maintain expertise in credentialing regulations, payer requirements, provider enrollment processes, and industry best practices
• Coordinate credentialing activities related to new programs, services, locations, and revenue streams
• Participate in audits, accreditation reviews, and compliance activities as required
• Attend virtual and in‑person internal and external training, conferences, and meetings as appropriate
• Maintain compliance with HIPAA, mandated reporting requirements, and professional ethical guidelines
• Travel within the designated service area
• Perform other duties as assigned

Requirements

• A high school diploma or GED equivalent is required
• A bachelor's degree in business, Public Health, Healthcare Administration, or a related field is preferred
• 5 years of experience in provider credentialing and payer enrollment in a healthcare setting is required
• 3 years of supervisory or management experience in a healthcare credentialing role is required
• Experience with Ohio Medicaid provider enrollment and credentialing is required
• Experience working with credentialing systems and electronic health records is required
• Experience utilizing NPPES, CAQH, Ohio Medicaid PNM, and payer enrollment portals is required
• Knowledge of credentialing standards, provider enrollment requirements, and healthcare regulatory compliance