RCM Manager Credentialing

Job Description

OVERVIEW

The Credentialing Manager owns end-to-end governance of the provider credentialing function, spanning internal intake and outsourced vendor operations. Internal credentialing intake is performed by dedicated coordinators/analysts, while day-to-day credentialing operations application preparation, payer submission, follow-up, and re-credentialing processing are executed by contracted vendor resources. This role may require hands-on credentialing operations while owning oversight, quality assurance, and reporting across the entire credentialing lifecycle, ensuring vendor performance meets contractual, compliance, and client service standards. The Credentialing Manager is the primary escalation point for credentialing issues, the owner of vendor accountability metrics, and the connective layer between internal intake, vendor operations, compliance, and client-facing leadership.

CORE RESPONSIBILITIES

• Own internal intake process – ensure new-provider and re-credentialing packets are complete, accurate, and on schedule before vendor handoff.

• Set and enforce data-quality standards for intake (CAQH, licensure, malpractice, education/training, payer requirements) so vendors receive submission-ready files.

• Manage the intake team – workload distribution, training, and performance coaching for coordinators/analysts.

• Serve as handoff gatekeeper, resolving discrepancies between internal intake and vendor operations before they cause delays.

• Own day-to-day and strategic vendor oversight for all credentialing operations (submissions, payer follow-up, enrollment tracking, re-credentialing/revalidation), including SOW/SLA accountability and governance cadences (syncs, QBRs).

• Manage escalations and root-cause resolution for stalled enrollments, payer rejections, CMS I&A/surrogacy issues, and systemic vendor errors, and support vendor transitions/onboarding/offboarding.

• Administer the QA program – audit vendor work for accuracy, timeliness, and completeness; identify and trend error patterns; own remediation and corrective-action plans.

• Partner with Compliance to ensure credentialing practices meet NCQA, CMS, and payer-specific standards across internal and vendor work.

• Own performance reporting – maintain the credentialing scorecard (cycle time, turnaround, first-pass rate, backlog aging, SLA attainment), exception tracking, and present results/audit-ready records to leadership.

• Act as primary stakeholder liaison – communicate credentialing status, risk, and vendor performance to Operations, Client Services, Compliance, and leadership, and partner on vendor strategy/capacity planning.

REQUIRED QUALIFICATIONS

• Bachelor’s degree in healthcare administration, business, or a related field or equivalent professional experience.

• 8+ years of progressive experience in provider credentialing or payer enrollment, including 3+ years in a lead, management or vendor-oversight capacity.

• Demonstrated experience managing outsourced/BPO credentialing operations, including SLA management, vendor governance, and escalation resolution.

• Experience running a QA program for credentialing or a comparable back-office operational function.

PREFERRED QUALIFICATIONS

• Certified Provider Credentialing Enrollment Specialist or equivalent payer-enrollment credentials.

• Strong working knowledge of CAQH, PECOS, CMS I&A, NPPES, and payer-specific enrollment portals and requirements.

• Proven vendor management skills: SLA design and enforcement, performance score carding, contract-aligned accountability, and difficult-conversation escalation.

• Strong QA program design and audit skills, with the ability to identify systemic issues versus one-off errors and drive root-cause corrective action.

• Analytical proficiency with Excel and reporting tools; comfort building and maintaining scorecards, trackers, and dashboards from vendor data exports.

• Excellent stakeholder communication skills, with the ability to represent credentialing performance and risk to senior and client-facing leadership.

• Sound understanding of NCQA, CMS, and payer credentialing compliance standards.

• Ability to manage multiple vendors, client books, and concurrent escalations in a fast-paced, metrics-driven en

Compensation for this job is subject to market conditions, geographic considerations, the candidate’s unique skills and experience, state and local laws, and budget. Our commitment to pay transparency is a testament to our dedication to creating a fair, equitable, and inclusive workplace. By continuously analyzing market trends, staying abreast of changes in state laws, and making budgetary adjustments accordingly, we strive to ensure that our compensation practices reflect the value we place on our associates’ unique contributions and support their professional growth.

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Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?

Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.

Visa Sponsorship is not offered for this position.

At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.

Veradigm’s policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.

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