Credentialing Manager

Description:

Job Summary:

The Credentialing Manager will oversee and manage the credentialing and re-credentialing

processes for all physicians, healthcare providers, and allied health professionals at the Los

Angeles Center for Ear, Nose, Throat, and Allergy (LACENTA). The role will ensure

compliance with federal, state, and regulatory requirements while maintaining high standards for

quality and efficiency. The Credentialing Manager will be a key part of the operations team and

collaborate closely with clinical staff, administrative departments, and regulatory bodies to

facilitate the smooth onboarding of healthcare providers.

Requirements:

Job Duties and Responsibilities:

Credentialing Process Management

Oversee and coordinate the credentialing and re-credentialing process for all physicians

and healthcare professionals, ensuring timely submissions to health insurance companies,

hospital privileges, and regulatory agencies.

Compliance

Ensure all credentialing practices comply with relevant federal, state, and insurance

regulations (e.g., CMS, NCQA, JCAHO, etc.). Monitor changes in regulations and apply

them to the credentialing processes as needed.

Provider Database Management

Maintain and manage an up-to-date provider database, ensuring accurate records of

licensure, certifications, malpractice insurance, and education. Regularly audit files to

confirm adherence to accreditation standards.

Documentation and Reporting

Prepare and submit credentialing packets to insurance companies and other relevant

parties. Maintain accurate and complete records of credentialing files for all providers.

Insurance Contracting

Act as a liaison between the organization and insurance payers to ensure all credentialing

information is up-to-date and providers are appropriately listed in insurance networks.

Assist in managing the enrollment of new providers with health insurance plans.

Staff Training and Development

Provide ongoing training for administrative and clinical staff on credentialing processes,

documentation, and compliance requirements.

Problem Resolution

Act as the primary point of contact for providers and insurance companies with questions

regarding credentialing status. Troubleshoot and resolve issues in a timely manner.

Collaboration

Work closely with HR, legal, and clinical departments to ensure that all providers meet

the necessary standards and are in good standing for employment. Assist with onboarding

new hires, ensuring all credentialing paperwork is complete before provider start dates.

Qualifications and Experience:

To perform this job successfully, an individual must be able to perform each essential duty

satisfactorily. The requirements listed below are reflective of the knowledge, skill, and/or ability

required.

Education

Bachelor’s degree in healthcare administration, business, or a related field (or equivalent

work experience).

Experience

Minimum of 2 years of credentialing experience in a healthcare environment, with a

strong background in managing physician credentialing, preferably in a multi-specialty

setting.

Certifications

Certification in healthcare credentialing (e.g., CPCS or CPMSM) preferred.

Knowledge and Skills

? In-depth knowledge of healthcare regulations, including CMS, HIPAA, and

insurance credentialing requirements.

? Strong organizational and communication skills.

? Proficiency in Microsoft Office Suite (Word, Excel, Outlook).

? Experience with credentialing software (e.g., Echo, Verity, etc.) is preferred.

? Strong attention to detail and ability to manage multiple tasks with competing

deadlines.

Personal Attributes

? Self-motivated, proactive, and able to work independently.

? Strong problem-solving skills and a team-oriented attitude.

? High level of confidentiality and professionalism.

Physical Demands:

The physical demands described here are representative of those that must be met by an

employee to successfully perform the essential functions of this job. Individual will be required

to:

? Sit for long periods at a time.

? Use hands and fingers in repetitive motions, daily.

? Ability to lift, push, pull up to 20 lbs. periodically.

? Travel to clinic locations or sites as needed.

? Reasonable accommodations may be made to enable individuals with disabilities to

perform the essential functions.