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Credentialing Provider Enrollment Manager Jobs (NOW HIRING)

The Provider Enrollment Specialist II will assist Management in maintaining provider enrollment ... Documents assignments in the Credentialing/Provider Enrollment tracking system per the department ...

Manage provider enrollment team resources and workflow to reach maximum efficiency and productivity levels, as well as provide solutions on how to improve in this area. * Participate and ensure ...

Identify discrepancies with credentialing documentation or history and notify the * Provider Enrollment Manager of significant discrepancies. * Enroll providers with payers by providing information ...

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

As of Jun 11, 2026, the average yearly pay for credentialing provider enrollment 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 the difference between Credentialing Provider Enrollment Manager vs Credentialing Specialist?

AspectCredentialing Provider Enrollment ManagerCredentialing Specialist
CertificationsOften requires industry certifications like CPCS or CPMSMMay hold certifications such as Certified Provider Credentialing Specialist
Work EnvironmentManages teams, oversees enrollment processes, interacts with payersPerforms credentialing tasks, verifies provider information, processes applications
Employer & Industry UsageUsed in healthcare organizations, insurance companies, and credentialing firmsCommonly employed in healthcare facilities, billing companies, and credentialing departments

The Credentialing Provider Enrollment Manager typically oversees the entire provider enrollment process, managing teams and strategic planning. In contrast, the Credentialing Specialist focuses on executing credentialing tasks and verifying provider credentials. Both roles are essential in healthcare credentialing but differ in scope and responsibilities.

What are some common challenges faced by a Credentialing Provider Enrollment Manager, and how can they be addressed?

Credentialing Provider Enrollment Managers often encounter challenges such as managing tight deadlines for provider onboarding, navigating complex payer requirements, and ensuring compliance with ever-changing regulations. Maintaining clear communication with providers and payers, staying updated on industry standards, and implementing robust tracking systems can help address these issues effectively. Regular training for staff and fostering a collaborative team environment are also key strategies for overcoming these challenges and ensuring smooth enrollment processes.

What is a Credentialing Provider Enrollment Manager?

A Credentialing Provider Enrollment Manager is a professional responsible for overseeing the process of verifying healthcare providers’ qualifications and enrolling them with insurance payers and government programs. They ensure that all providers meet the necessary standards and maintain compliance with regulatory and organizational requirements. Their role includes managing documentation, coordinating with providers and payers, and staying up to date with changes in credentialing and enrollment policies. This position is essential for healthcare organizations to ensure that providers are authorized to deliver services and receive reimbursement.

What are the key skills and qualifications needed to thrive as a Credentialing Provider Enrollment Manager, and why are they important?

To thrive as a Credentialing Provider Enrollment Manager, you need in-depth knowledge of healthcare regulations, credentialing standards, and provider enrollment processes, often supported by a bachelor’s degree in healthcare administration or a related field. Familiarity with credentialing software (such as CAQH or Verity), database management, and understanding of payer requirements are typically essential. Exceptional organizational skills, attention to detail, and strong communication abilities help in managing complex documentation and facilitating provider relations. These competencies ensure accurate, timely provider onboarding and regulatory compliance, which are critical for uninterrupted patient care and organizational success.
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Credentialing & Provider Enrollment Specialist

Credentialing & Provider Enrollment Specialist

Greater Philadelphia Health Action

Philadelphia, PA • On-site

Full-time

Medical, Dental, Life, Retirement

Posted 8 days ago


Job description

LOCAL CANDIDATES ONLY. Greater Philadelphia Health Action, Inc. (GPHA) is a cutting edge Joint Commission-Accredited healthcare organization and premier provider of primary medical, dental, and behavioral healthcare for more than 55 years. We are one of the largest ambulatory health centers in the region!

Because of our success and stability, GPHA has become an employer of choice, offering our employees competitive salaries and a full array of benefits and rewards to include performance bonuses, medical, dental, and life insurance, tuition reimbursement, paid-time-off, holiday pay, 401(k) with LUCRATIVE company match, and a collaborative work environment.

We are presently seeking a second Credentialing & Provider Enrollment Specialist at GPHA’s Executive Offices located at Carl Moore Health Center in Southwest Philadelphia. Hybrid work schedule is available, but this position must work at least 3 days in the office, so we ask that candidates reside within a commutable distance to Philadelphia. LOCAL CANDIDATES ONLY.

The Credentialing & Provider Enrollment Specialist is responsible for credentialing, re-credentialing, provider enrollments and files maintenance for GPHA’s Licensed Independent Practitioners (LIP’s), and must ensure proper enrollment of all GPHA Dental (and potentially medical and behavioral health as may be required) providers into the various payer programs, noting that most dental provider enrollments into our plans are facilitated via CAQH, but some dental plans may still require manual applications, so must expertly facilitate these as well. Credentialing & Provider Enrollment Specialist must also manage provider numbers for all GPHA providers and locations, perform ALL duties associated with the daily responsibilities of the various Managed Care programs to ensure ALL providers’ files are kept up to date, and that they are enrolled (credentialed) properly, and re-credentialed properly in ALL plans with no delays or lapses as a participating provider. The Credentialing & Provider Enrollment Specialist must also always provide excellent customer service and use appropriate language in ALL Communications.

Successful candidates will have at least two to four years of college education plus a minimum of two years’ credentialing experience in a Health Center environment (or Managed Care Organization (MCO)), with a detailed understanding of provider enrollment and payment processes. Good computer and analytical skills. Good interpersonal and communication (both written and verbal) skills required. Again, Local Candidates only, please.
GPHA is an Equal Opportunity Employer. GPHA does not and will not discriminate in employment and personnel practices to include hiring, transferring and promotion practices on the basis of race, color, sex, age, handicap, disability, religion, religious creed, ancestry, national origin, or any other basis prohibited by applicable law.