Job Description
Job title and summary
Job Title:
Credentialing Manager Department:
Credentialing Department Location:
Miami Lakes, Florida (100% Onsite) Status:
Full-Time The Credentialing Manager will build and lead a new Credentialing Department for a growing mental and medical health company. This role is responsible for overseeing all credentialing, recredentialing, and payer enrollment processes for an AHCA-licensed clinic, ensuring that all providers meet regulatory, payer, and internal compliance standards. Key responsibilities Lead, supervise, and develop the credentialing team, including assigning workload, monitoring performance, and providing training and support. Oversee all credentialing and recredentialing activities for medical, behavioral health, and allied providers, ensuring timely and accurate completion. Ensure compliance with AHCA requirements, payer standards, and applicable state and federal regulations related to credentialing and enrollment. Establish, implement, and continuously improve department policies, procedures, workflows, and tracking systems for credentialing and payer enrollment. Manage primary source verification for licenses, education, board certifications, malpractice coverage, work history, and other required documents. Oversee maintenance of credentialing databases and provider files, ensuring data accuracy, completeness, and confidentiality at all times. Direct and monitor payer enrollment processes with Medicaid, Medicare, and commercial plans, including initial applications, updates, and terminations. Track expirations for licenses, certifications, malpractice insurance, and other required documents and ensure timely renewals to prevent gaps. Prepare and present reports, status updates, and metrics to leadership on credentialing progress, turnaround times, and compliance issues. Support internal and external audits and respond to payer, regulatory, or accreditation reviews related to credentialing. Collaborate closely with Operations, HR, Compliance, and Billing/Revenue Cycle to support smooth provider onboarding and billing readiness. Required qualifications Minimum 7-10 years of hands-on provider credentialing experience in a healthcare setting, with strong preference for experience in an AHCA-licensed clinic. Prior experience in a lead, supervisory, or manager-level credentialing role overseeing processes and/or staff. Strong knowledge of credentialing standards, AHCA requirements, Medicaid and Medicare enrollment, and commercial payer policies. Demonstrated experience building or improving credentialing workflows, policies, and tracking systems. Proficiency with credentialing databases and payer portals, as well as Microsoft Office (Excel, Word, Outlook). Excellent organizational skills, attention to detail, and ability to manage multiple priorities and deadlines. Strong written and verbal communication skills and a professional, collaborative approach with providers and internal teams. Clean background, high level of reliability, and strong attendance and punctuality. Preferred qualifications Experience credentialing both behavioral health and medical providers across multiple payer types. Experience with CAQH, PECOS, NPPES, and delegated credentialing or payer audits. Credentialing-related certification (CPCS, CPMSM, or similar) is preferred. Work location This position is 100% onsite at the Miami Lakes office; remote or hybrid work is not available for this role. Candidates must have reliable transportation and be able to work standard business hours with flexibility for occasional extended hours based on organizational needs. Pay:
$50,747.16 - $65,000.00 per year Benefits:
Paid time off Work Location:
In person
