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Credentialing Provider Data Manager Jobs (NOW HIRING)

Biogen

Data Manager

Cambridge, MA · On-site

$117K - $157K/yr

As a Data Manager in the Implantable Device Unit, you will play a crucial role in supporting the ... This position is vital for providing leadership and hands-on support for effective study data ...

VIVA Health

Senior Provider Data Analyst

Birmingham, AL

$80K - $101K/yr

The Senior Provider Data Analyst is responsible for supporting and developing VIVA HEALTH ... Credentialing, Value Based Programs, Medical Management, Finance, Information Systems and other ...

Altais, Inc.

Senior Manager, Credentialing

Conduct audits of the credentialing database, confirming accurate input of provider data, and ... Manages vendor systems and services performance * Leads credentialing committee effectiveness in ...

Altais

Senior Manager, Credentialing

California, MO · On-site

Conduct audits of the credentialing database, confirming accurate input of provider data, and ... Manages vendor systems and services performance * Leads credentialing committee effectiveness in ...

Altais, Inc.

Senior Manager, Credentialing

Conduct audits of the credentialing database, confirming accurate input of provider data, and ... Manages vendor systems and services performance * Leads credentialing committee effectiveness in ...

Centene

Manager, Credentialing

New Rochelle, NY

$70K - $126K/yr

... providers. * Apply principles of logical or scientific thinking to define problems, collect data ... years of credentialing or provider data experience. Experience in a managed care or insurance ...

Hbculifestyle

Data Manager

Manhattan, NY · On-site

The New York City Independent Budget Office (IBO), a nonpartisan, independent agency that provides ... Under the direction of the Assistant Director for Data Acquisition and Governance, the Data Manager ...

Nadia Care

Credentialing & Payer Operations Manager

$80K - $90K/yr

The Credentialing & Payer Operations Manager will own end-to-end provider licensing, payer ... Data Bank (NPDB) to ensure clean provider rosters. * Stay up to date on evolving healthcare ...

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How much do credentialing provider data manager jobs pay per year?

As of Sep 13, 2026, the average yearly pay for credentialing provider data manager in the United States is $85,031.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,000.00 and $94,500.00 per year, depending on experience, location, and employer.

What is a credentialing provider data manager?

A Credentialing Provider Data Manager is a professional responsible for overseeing the collection, verification, and management of healthcare provider data for credentialing purposes. They ensure that all provider information meets regulatory and organizational standards, and that records are accurate and up-to-date. This role often involves coordinating with providers, insurance companies, and regulatory agencies to facilitate the credentialing process and maintain compliance. Additionally, they may supervise credentialing staff and implement data management systems to enhance workflow efficiency.

What skills and qualifications are needed to thrive as a credentialing provider data manager?

To thrive as a Credentialing Provider Data Manager, you need expertise in healthcare credentialing processes, data management, and compliance standards, often backed by a bachelor’s degree in healthcare administration or a related field. Familiarity with credentialing software (like CAQH, VerityStream), database systems, and knowledge of industry regulations such as NCQA and CMS is typical. Attention to detail, strong organizational skills, and the ability to communicate clearly with providers and regulatory bodies are crucial soft skills. These competencies ensure accurate provider data, regulatory compliance, and efficient credentialing operations, which are essential for patient safety and organizational integrity.

How does a credentialing provider data manager collaborate with other departments to ensure data accuracy and regulatory compliance?

A Credentialing Provider Data Manager often works closely with teams such as credentialing specialists, compliance officers, IT, and provider relations to maintain accurate provider records and meet regulatory requirements. This collaboration involves regular meetings to review data discrepancies, sharing updates on policy or regulatory changes, and coordinating the implementation of data management solutions. Effective cross-functional communication is essential to resolve issues quickly and ensure that all provider data is current, complete, and in line with industry standards.

What cities are hiring for Credentialing Provider Data Manager jobs?

Cities with the most Credentialing Provider Data Manager job openings:

What are popular job titles related to Credentialing Provider Data Manager jobs?

For Credentialing Provider Data Manager jobs, the most frequently searched job titles are:

Provider Enrollment and Credentialing Specialist

Atlanta, GA • On-site

Ortho Sport and Spine Physicians
Outpatient Health Care • 201 - 500 employees
Learn more about Ortho Sport and Spine Physiciansexternal

Full-time

Re-posted 9 days ago

Job description

Description
Position Summary:
The Credentialing Specialist is responsible for managing all aspects of the credentialing, recredentialing, and privileging processes for providers delivering patient care within the clinic and Ambulatory Surgery Center (ASC). This role ensures that all providers and the ASC maintain active, compliant credentials and privileges with health plans, hospitals, and regulatory entities. The Specialist will maintain accurate provider data across credentialing databases and systems, ensure timely renewal of all required documents, and support organizational compliance with payer and agency requirements.
Key Responsibilities
Credentialing & Compliance
  • Maintain accurate and up-to-date credentialing data for all providers across internal databases and online systems.
  • Complete and manage provider credentialing and recredentialing applications, ensuring timely submission and proactive follow-up.
  • Ensure all provider documents-including state licenses, DEA certificates, malpractice coverage, and certifications-are current and compliant.
  • Maintain thorough understanding of evolving health plan, regulatory, and agency requirements.
  • Set up and maintain provider profiles in credentialing and payer enrollment systems.
  • Track all license, certification, malpractice, and DEA expiration dates to ensure timely renewals.
  • Ensure all practice and provider addresses are accurately reflected with health plans, agencies, and third-party entities.
  • Process and track hospital appointment and reappointment applications for provider privileges.
  • Audit health plan directories regularly to ensure accurate provider listings.
  • Maintain and update fee schedule contacts with insurance payers.

Billing & Enrollment Support
  • Apply working knowledge of medical billing and insurance claims rules as related to credentialing and payer enrollment.
  • Review EOBs to identify denial trends related to credentialing or enrollment issues.
  • Maintain and update CAQH profiles to ensure continuous payer compliance.

Other Duties
  • Perform additional responsibilities and special projects as assigned.

Qualifications
Education:
  • High school diploma or equivalent required.
  • Associate degree preferred.

Experience:
  • Minimum 2 years of credentialing or provider enrollment experience.
  • 1-2 years of medical billing and insurance follow-up experience preferred.
  • Experience with eClinicalWorks (eCW) preferred.

Skills & Competencies
  • Strong knowledge of credentialing and provider enrollment processes.
  • Excellent organizational skills with the ability to manage multiple priorities.
  • Exceptional attention to detail and accuracy.
  • Strong verbal and written communication skills, including professional correspondence.
  • Ability to analyze data, research discrepancies, and solve problems effectively.
  • Self-motivated with the ability to work independently with minimal supervision.
  • Ability to build and maintain positive working relationships with providers, leadership, and external partners.
  • Proficiency with Microsoft Office (Word, Excel, Access) and online credentialing systems.
  • In-depth understanding of medical billing rules and insurance claims processes.
  • Ability to review EOBs and identify credentialing-related denial patterns.
  • Extensive experience with CAQH management and upkeep.

Ortho Sport and Spine Physicians is an Equal Opportunity Employer and does not discriminate in its employment practices on the basis of race, religion, sex, color, national origin, age, disability, citizenship, genetic information, veteran status, military service, or any other characteristic protected by federal law or Georgia law.
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