Sr. Manager of Credentialing and Contracting

Sr. Manager of Credentialing and Contracting Behavioral Health Solutions - 4.1 Henderson, NV Job Details 6 hours ago Benefits Paid holidays Health insurance Dental insurance Paid time off Vision insurance 401(k) matching Qualifications Medicare Managed care organization experience Provider enrollment for medical credentialing Medicaid Full Job Description Behavioral Health Solutions is seeking an experienced Senior Manager of Credentialing and Contracting to oversee provider credentialing, payer enrollment, and payer contracting operations across our growing multi-state healthcare organization. Position Overview The Senior Manager of Credentialing and Contracting will be responsible for managing the day-to-day execution of credentialing, recredentialing, payer enrollment, Medicare and Medicaid enrollment, facility credentialing, and payer contracting activities across the organization while partnering closely with their direct supervisor. This individual will also support new payer contract opportunities, assist with contract negotiation and rate review, maintain payer relationships, and ensure providers and entities are enrolled, credentialed, and contracted in a timely and compliant manner. This role requires someone who can do more than process applications. The right candidate will understand the full connection between credentialing, contracting, payer enrollment, provider readiness, revenue cycle, and business growth. This person should be able to manage details, improve processes, communicate clearly across departments, and help ensure Behavioral Health Solutions is positioned to expand services in a timely and compliant manner. Key Responsibilities Manage provider credentialing, recredentialing, payer enrollment, facility credentialing, and related compliance processes across multiple states. Oversee enrollment activities with Medicare, Medicaid, managed Medicaid, Medicare Advantage, commercial payers, and other payer partners. Support the pursuit of new payer contracts to align with BHS' growth, new market expansion, and service line development. Assist with reviewing, negotiating, and tracking payer contract terms, reimbursement rates, fee schedules, administrative requirements, timely filing provisions, credentialing timelines, and renewal or termination language. Manage provider and entity enrollment through CAQH, PECOS, NPI, Medicaid portals, payer applications, and other required platforms. Maintain accurate and organized credentialing files, payer enrollment records, payer contracts, amendments, fee schedules, renewal dates, and payer requirements. Track credentialing timelines, payer enrollment status, contract status, recredentialing deadlines, revalidation dates, and provider billing readiness. Partner closely with direct leadership, revenue cycle, operations, finance, compliance, and clinical leadership to ensure providers are ready to deliver services and bill appropriately. Identify, research, and resolve credentialing, enrollment, payer setup, denial, reimbursement, and contract interpretation issues. Create and maintain SOPs, tracking tools, dashboards, reports, and escalation workflows to support consistency and accountability. Monitor payer requirements and communicate changes that may impact enrollment, credentialing, contracting, billing, or operational readiness. Serve as a key internal resource for credentialing, payer enrollment, Medicare, Medicaid, payer contracting, and payer participation requirements. Qualifications Bachelor's degree in healthcare administration, business administration, or a related field preferred; equivalent experience may be considered. Minimum of 5-7 years of progressive experience in healthcare credentialing, payer enrollment, payer contracting, provider enrollment, or a closely related function. Experience working directly with payer representatives required. Experience with Medicare and Medicaid enrollment required. Experience supporting payer contract review, payer negotiations, or rate discussions strongly preferred. Multi-state healthcare experience strongly preferred. CPCS, CPMSM, or similar credentialing certification preferred but not required. What You'll Bring Strong healthcare credentialing, payer enrollment, and payer contracting experience. Demonstrated experience working with Medicare, Medicaid, managed Medicaid, Medicare Advantage, commercial payers, and payer portals. Ability to support payer contract review, rate evaluation, term tracking, and contract negotiation efforts. Strong understanding of

CAQH, PECOS, NPI

records, Medicaid enrollment, payer applications, recredentialing, revalidation, and payer participation requirements. Ability to interpret payer contracts, amendments, fee schedules, reimbursement language, and key operational requirements. Strong understanding of how credentialing and contracting impact billing, denials, revenue cycle performance, provider onboarding, and market readiness. Highly organized with strong follow-through, attention to detail, and the ability to manage multiple priorities at once. Strong communication skills with the ability to work across various departments and clinical teams. Ability to identify process gaps, improve workflows, and create structure in a growing multi-state healthcare organization. Comfortable operating independently while escalating issues appropriately and keeping their direct leadership informed. Why Join Behavioral Health Solutions? Behavioral Health Solutions is a growing behavioral healthcare organization dedicated to improving access to high-quality mental health services in long-term care and healthcare settings. Our team is driven by a commitment to operational excellence, compassionate care, and meaningful impact in the communities we serve. Benefits Competitive Earnings Hands-on Training and Supervision Work-Life Balance PTO and Paid Holidays A comprehensive benefits package (Medical, Dental, Vision, Life, and more) 401k with company match