Credentialing Manager | ABA

Behavior Frontiers

Salary Range: $80,000 - $85,000

Responsibilities

• Team Leadership & Daily Operations
• As the leader of our Credentialing Department, you will supervise and manage daily operations, focusing on workflow distribution, prioritization, and employee development. You will actively monitor application statuses, processing timelines, and department work queues to quickly identify and resolve delays or barriers. In this capacity, you will serve as the primary escalation point for complex credentialing, enrollment, contracting, and payer-related issues. You will also drive team success through continuous training, performance management, and quality assurance initiatives.
• Credentialing, Compliance & Data Integrity
• You will oversee all credentialing, recredentialing, enrollment, and provider maintenance activities to ensure strict compliance with payer, regulatory, and organizational requirements. A core part of this role involves ensuring that provider licenses, certifications, NPI records, and CAQH profiles remain perfectly current. To maintain operational visibility and data integrity, you will manage departmental databases and tracking tools while conducting regular audits of provider files. You will also be responsible for developing and maintaining the department's standard operating procedures (SOPs) and policies, all while upholding strict confidentiality regarding protected health information, employees, and company operations.
• Stakeholder Collaboration & Strategic Growth
• Collaboration is essential in this role. You will build and maintain effective relationships with payer representatives and regulatory agencies, while partnering internally with Operations, Recruiting, HR, and Clinical Leadership to support seamless provider onboarding and location roster maintenance. As the organization grows, you will participate in strategic planning related to market expansion by supporting contract development initiatives, researching new funding sources, and staying highly informed on federal, state, and accreditation requirements. By tracking key department metrics, you will prepare reports for leadership and lead continuous process improvement initiatives to increase the department’s overall efficiency and scalability. You will also take on special projects and additional duties as assigned.

Requirements

Qualifications

• · Education: Bachelor's degree in Healthcare Administration, Business Administration, Healthcare Management, or a related field preferred; equivalent experience may be considered.
• · Experience: 3–5 years of healthcare credentialing, provider enrollment, contracting, or related experience required.
• · Leadership: Previous supervisory, lead, or management experience preferred.
• · Multi-State Expertise: Multi-state credentialing and provider enrollment experience strongly preferred.
• · Payer Knowledge: Experience working with commercial insurance plans, Medicaid, Medicare, Tricare, and other funding sources preferred.
• · Systems Proficiency: Experience with CAQH, NPPES, PECOS, payer portals, and credentialing databases.
• · Core Competencies: Strong organizational, analytical, problem-solving, and project management skills.
• · Time Management: Ability to manage multiple priorities, meet deadlines, and collaborate effectively across departments.