Credentialing Manager

Responsibilities include, but are not limited to, the following:

• Process initial credentialing and recredentialing applications for healthcare providers.  


• Prepare and submit credentialing and privileging applications for hospitals, ambulatory surgery centers, and insurance payors.  


• Review, verify, and process credentialing applications, including online application submissions.  


• Perform primary source verification for licenses, education, training, board certification, and work history. 


• Track license and certification expirations to ensure timely renewals, including but not limited to state licenses, Drug Enforcement Administration (DEA), Controlled Dangerous Substances (CDS), board certifications, Continuing Medical Education (CME), Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), Pediatric Advanced Life Support (PALS), infection control, child abuse courses, and health assessment requirements.  


• Maintain credentialing and privileging files in compliance with American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and hospital medical staff requirements and ensure files are audit-ready at all times.  


• Maintain provider information in credentialing database systems.  


• Maintain hospital affiliation grid on the company intranet.  


• Track and log Continuing Medical Education (CME) credits for providers. 


• Evaluate hospital usage prior to renewing existing privileges.  


• Coordinate with hospital medical staff offices and insurance payors to ensure timely processing of applications and renewals. 


• Work with Accounts Payable to ensure licensing fees, application fees, hospital dues, and medical staff dues are paid on time. 


• Generate credentialing reports and status updates as needed.  


• Ensure compliance with all regulatory, accreditation, and organizational credentialing requirements. 


• This position requires strict attention to detail, the ability to manage multiple deadlines, and the ability to work independently to ensure providers remain continuously credentialed and privileged without lapse.