Provider Credentialing and Enrollment Manager

Title: Provider Credentialing & Enrollment Manager

Location: Remote - United States

Work Type: Remote, Full Time

Job ID: 2026-R0372

Job Description:

Summary

This is a remote position

The Provider Credentialing and Enrollment Manager will oversee the processing of applications and reapplications for providers. This role ensures compliance with national accreditation standards and state and federal regulatory requirements. The position requires a subject matter expert in all state bylaws of the credentialing process and application management, specifically tailored for urgent care environments.

Description

Responsibilities

• Ensure provider staffiscredentialed and enrolled with payers to ensure sufficient clinical coverage and minimal claims reimbursement denials

• Develop and implement policies and procedures for the credentialing and recredentialing process, ensuring they meet industry standards and organizational needs

• Manage the primary source verification of education, training, board certification, work history, and licensure of healthcare providers

• Maintain CMS NPPES reporting

• Support internal credentialing committee in evaluation of newly hired staff

• Facilitate the resolution of discrepancies or concernsregardingapplicants’ credentials, working closely with medical staff leadership and healthcare providers

• Maintainaccurateand confidential credentialing databases and files, ensuring the security and integrity of sensitive provider information

• Effectively communicateaccurateenrollment and credentialing status throughout the organization to support effective decision making

• Assistthe accounts receivable department with credentialing related payer denials

• Coordinate with counsel and compliance on malpractice and related insurance coverage

• Serve as the lead expert on all state-specific bylaws, ensuring that urgent care and health system applications adhere to varying regional legal standards.

Compensation Range: $95,000-110,000

The salary/rate range listed here has been provided to comply with local regulations and represents a potential base salary/rate for this role. Please note that actual salaries/rates may vary within this range above or below, depending on experience and location. We look at compensation for each individual and based on experience and qualifications.

Qualifications

• Minimum of five (5) years of progressively responsible operational or consulting experience in provider credentialing and enrollment in an outpatient setting

• Provenexpertisein all state bylaws governing the credentialing process for urgent care or multi-site health systems.

• Knowledge and experience of the healthcare industry or medical financial operations

• Possess ability toidentifypatterns and conduct root cause analysis

• Maintainaccurateand up-to-date provider credentialing information in the database

• Experience with CAQH (Council for Affordable Quality Healthcare) database and application process

• Strong attention to detail and organizational skills

• Demonstrated ability to manage multiple, concurrently running projects and adapt to changing deadlines, competing priorities and unexpected assignments

EEO Statement

PM Pediatric Care is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status or any other characteristic protected by law.