Manager, Licensing & Credentialing

Licensing Management:

• Own the CertifyOS vendor relationship, including budget accountability and renewal negotiations.
• Direct the day-to-day work CertifyOS performs and hold the vendor accountable to defined service levels.
• Oversee all provider licensing and license renewals across multiple states.

Provider Credentialing:

• Manage all commercial, Medicaid, and managed Medicaid payer credentialing activities.
• Personally oversee provider enrollment, re-credentialing, and payer applications from submission through approval.
• Track credentialing status and proactively resolve enrollment delays.

Payer Roster Management:

• Own payer roster management across all contracted health plans.
• Ensure provider roster submissions are accurate, timely, and synchronized with payer systems.
• Perform routine payer roster audits to identify and correct discrepancies.

Payer Relationship Management:

• Develop and maintain strong relationships with commercial and government payer credentialing representatives.
• Lead recurring monthly payer operational meetings focused on credentialing escalations and process improvement.
• Serve as the organization's primary escalation point for payer credentialing issues.