Credentialing Manager

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $77.8k - $81.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 5%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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BetterHealth

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2014

🏥 Healthcare

🧘 Wellness

👥 B2C

Healthcare • Wellness • B2C

BetterHealth is a forthcoming consumer-facing health and wellness website using the Philippine domain betterhealth. ph. The site currently displays a "Launching Soon" landing page with an email sign-up for updates and promotions, a contact form, cookie and reCAPTCHA notices, and a 2026 copyright. Public information is limited; no specific products or services are listed yet, but the branding and site content indicate a focus on health/wellness for consumers in the Philippines.

📋 Description

• Provide strategic oversight of credentialing, licensing, recredentialing, privileging, and payer enrollment operations • Establish departmental standards, policies, and performance metrics • Ensure compliance with federal, state, payer, and accreditation requirements • Serve as escalation point for complex cases, audits, and payer or regulatory inquiries • Monitor regulatory changes and update policies and processes • Oversee internal audits and external payer or regulatory reviews • Supervise credentialing and licensing staff, including hiring, training, coaching, and performance management • Build scalable staffing models aligned with client growth and service demand • Conduct performance reviews and professional development planning • Develop SOPs, training materials, and quality assurance frameworks • Lead implementation and optimization of credentialing technology platforms and automation • Establish audit-ready systems for documentation, tracking, and compliance reporting • Ensure consistent primary source verification and documentation standards • Develop, price, and position credentialing and licensing services with executive leadership • Contribute to marketing materials, proposals, and client presentations • Support client discovery calls, solution design, and contract development • Identify new market opportunities and service line expansion • Collaborate with revenue cycle, compliance, legal, and operations teams • Act as subject matter expert in credentialing and licensing best practices • Align credentialing with billing, appeals, eligibility, and denial management processes • Provide executive-level oversight of credentialing-related impacts to revenue performance

🎯 Requirements

• Bachelor's degree in healthcare administration, Business, or a related field (or equivalent experience) • 5 to 8+ years of experience in provider credentialing, licensing, and payer enrollment • Expert knowledge of Medicare, Medicaid, managed care, and commercial payer requirements • Experience with quality management frameworks • Demonstrated experience building, managing, and leading operational teams • Experience with credentialing and PSV technology platforms • Excellent time management and organizational skills • Knowledge of NCQA credentialing standards preferred • CPCS, CPMSM, or equivalent professional credentialing certification preferred • Must be able to travel throughout and between facilities • Must be able to perform sedentary work and meet the listed physical demands

🏖️ Benefits

• Exempt employment • Professional development planning • Remote work arrangement