Position Description: Manager Credentialing (FULLY REMOTE ROLE)

Status: Salary, Exempt, Full-time

Reports to: VP of Program Operations

Supervises: Credentialing Team 

Job Summary: The Manager Credentialing is a hands-on, working manager responsible for the day-to-day credentialing, re-credentialing, licensing, and hospital privileging of all physicians and advanced practice providers contracted with Synergy Health Partners. This role carries an individual credentialing caseload while leading a three-person team, with particular emphasis on obtaining and maintaining privileges for surgeons and anesthesiologists across multiple hospital partners. The Credentialing Manager ensures provider files are complete, accurate, and compliant with hospital medical staff bylaws, state licensing requirements, and Joint Commission, NCQA, and CMS standards, and manages the medical malpractice coverage process for contracted providers. The Manager Credentialing may assist with other projects as assigned.

Essential Functions:

Credentialing and Privileging

• Personally prepares, submits, and tracks initial appointment and reappointment applications with hospital medical staff offices, maintaining an individual caseload alongside team leadership responsibilities
• Manages multi-hospital privileging for surgeons and anesthesiologists, including delineation of privileges requests, case and procedure logs, peer references, and proctoring/FPPE requirements
• Performs and oversees primary source verification of education, training, board certification, licensure, DEA, work history, malpractice claims history, and NPDB queries in accordance with Joint Commission and NCQA standards
• Coordinates credentialing timelines with facility partners and operations leadership so providers are fully credentialed and privileged before scheduled start dates
• Tracks reappointment cycles across all facilities and initiates renewals early enough to prevent any lapse in privileges
• Manages state medical license, DEA, and state controlled substance applications and renewals, including new-state licensure as the provider network expands
• Maintains CAQH ProView profiles and provider attestations where required

Medical Malpractice

• Completes professional liability (malpractice) applications and monitors issuance of coverage certificates
• Obtains claims history and loss runs needed for credentialing applications
• Maintains a complete, detailed malpractice inventory with routine reporting to leadership

Data, Systems, and Compliance

• Maintains complete, current provider files in the CRM and credentialing database, including state licenses, DEA certificates, board certifications, malpractice certificates, life support certifications (BLS/ACLS/PALS), and other required documents
• Monitors expirables for licenses, DEA, professional liability, and certifications; produces regular expiration reports and ensures timely renewal
• Works with the VP of Program Operations to refine CRM credentialing workflows, checklists, and policies, and recommends process improvements
• Supports audit readiness for hospital and regulatory reviews and safeguards the confidentiality of provider information

Team Leadership

• Leads, trains, and supervises a three-person credentialing team; assigns and balances caseloads, sets priorities, and serves as the escalation point for complex files
• Tracks team productivity, turnaround times, and file accuracy; completes performance reviews and annual assessments
• Develops and maintains standard operating procedures and training materials for the credentialing function

Communication

• Serves as the primary point of contact for hospital medical staff offices and facility partners, resolving application issues and escalations
• Communicates clearly and professionally with providers and Synergy leadership, including regular credentialing status reports
• Attends SHP meetings and presents credentialing updates at Operations meetings as requested

Work Environment:

This job may work in a remote environment. This role routinely uses standard office equipment such as computers, printers, and phones.

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.
• The employee is required to sit in front of a computer throughout the workday. The employee will infrequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision and working with two monitors.

Position Type/Expected Hours of Work:

Normal business hours are Monday through Friday. Some flexibility in hours may be allowed, but the employee must be available during the “core” work hours of 8:00 to 5:00 p.m. and must work a minimum of 37.5 hours each week to maintain full-time status. Occasional evening and weekend work may be required as job duties demand.

Travel: Little to no travel is required for this position.  

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Other duties may change with reasonable notice.  

This Job Description is subject to change.

FULLY REMOTE ROLE

Qualifications:

Education: Bachelor’s degree preferred; an equivalent combination of education and credentialing experience will be considered

5–8 years of physician credentialing experience, including hospital medical staff appointment and privileging

At least two years of experience supervising a small team

Strong experience in multi-hospital privileging for surgeons and anesthesiologists

Working knowledge of Joint Commission, NCQA, and CMS credentialing standards and hospital medical staff bylaws

Experience with credentialing software or CRM systems and primary source verification resources (NPDB, CAQH, state licensing boards, ABMS, AMA Physician Profile)

Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred

Competencies:

Comfortable leading a three-person team while carrying an individual workload; leads by example as a working manager

Excellent attention to detail and organizational skills; able to manage multiple deadlines across several facilities at once

Ability to research, analyze, and present information

Ability to work independently with initiative, sound judgment, and strong time management and decision-making skills

Ability to establish and maintain effective working relationships with providers, medical staff offices, management, staff, and contacts outside the organization

Strong verbal and written communication skills, including letters, memos, telephone communication, and emails

Maintains strict confidentiality of provider information

Proficient use of Microsoft Office applications (Word, Excel, Outlook) and internet resources