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Credentialing Provider Enrollment Manager Jobs in Michigan

ICONMA

Provider Credentialing Specialist

Detroit, MI · On-site

Two (2) to five (5) years of work experience in provider enrollment, contracting, medical practice or hospital business office role and/or credentialing related field required. * Knowledge of related ...

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Credentialing Provider Enrollment Manager information

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.

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 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 the most commonly searched types of Credentialing Provider Enrollment jobs in Michigan?

The most popular types of Credentialing Provider Enrollment jobs in Michigan are:

What are popular job titles related to Credentialing Provider Enrollment Manager jobs in Michigan?

For Credentialing Provider Enrollment Manager jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Credentialing Provider Enrollment Manager jobs in Michigan look for?

The top searched job categories for Credentialing Provider Enrollment Manager jobs in Michigan are:

What cities in Michigan are hiring for Credentialing Provider Enrollment Manager jobs?

Cities in Michigan with the most Credentialing Provider Enrollment Manager job openings:

Credentialing Provider Enrollment Manager jobs near you
Infographic showing various Credentialing Provider Enrollment Manager job openings in Michigan as of August 2026, with employment types broken down into 82% Full Time, 13% Part Time, 2% Temporary, 2% Contract, and 1% Nights. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution.

Credentialing & Provider Enrollment Specialist

Judson Center

Farmington Hills, MI

Full-time

Re-posted 8 days ago

Job description

Position: Credentialing amp; Provider Enrollment Specialist
Status: Full Time, Exempt
Reports to: Senior Manager of Quality and Corporate Compliance
Job Summary:
The Credentialing Specialist is responsible for preparing, submitting, and maintaining enrollment, credentialing and recredentialing, documentation for providers, clinicians and other billable providers.
Primary Duties and Responsibilities
  • Responsible for Compiling and maintaining current and accurate data for all providers
  • Responsible for Data entry and maintaining provider information in online databases and systems (CAQH, PECOS, and NPPES, Availity and any other systems as required.)
  • Responsible for Verification of State license, DEA, and Board certification
  • Ensures all required documentation is presented to government payers to receive provisional status to practice and be eligible for reimbursement
  • Responsible for Completing provider initial and recredentialing applications
  • Audits applications for accuracy and completeness
  • Responsible for revalidation requests issued by government payers
  • Responsible for Submitting completed credentialing and re-credentialing applications and supporting documentation to all requested payers
  • Compiles and maintains current data and master grid of all providers for agency roster
  • Maintains knowledge of current agency, state, county, and payor requirements for credentialing
  • Responsible for monitoring application progress and following up with necessary parties/payers as needed until confirmation of “in network” status has been received
  • Responsible for monitoring and maintaining copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. As well as tracking all state licenses, DEA, and board certification expirations for all providers to ensure timely renewal
  • Responsible for sending monthly updates to supervisors, program leads, and providers/clinicians
  • Utilizes strong research skills to gather pertinent information regarding providers
  • Assists in compilation of documents for audits conducted by Regulatory Agencies
  • Collaborates and executes Quality Assurance and Compliance Projects and Tasks as a Quality and Compliance Assistant including support of the Council of Accreditation Re-Credentialing Process and other related Quality and Compliance Administrative Tasks.
  • Undertakes additional projects and responsibilities as assigned by management to support the overall goals of the organization
  • All other duties as assigned
Qualifications
  • Associate degree and a minimum of 2 years related experience preferred; or at least four years related experience and training
  • Working knowledge of credentialing accreditation regulations, policies, and procedures
  • Certified Professional Credentialing Specialist (CPCS) certification preferred •
  • Payer Provider Enrollment: 1 year (Preferred) • Non-Profit: 1 year (Preferred)
Skills Required
  • Familiar with provider credentialing and recredentialing requirements
  • Strong analytic computer and software skills
  • Excellent interpersonal skills including excellent verbal and written communication skills
  • Ability to demonstrate a high degree of trust and confidentiality
  • Ability to work independently and assume assigned responsibilities
  • Skilled in efficiency, organization, time management, and prioritization
  • Ability to be flexible and function well in a fast-paced environment
  • Ability to communicate effectively and relate to people of diverse cultures
  • Ability to handle confidential information
Working Conditions
  1. Able to sit and work at a computer for extended periods
  2. Able to lift and move up 15 pounds occasionally
  3. Flexible schedule required; Requires regular and on-time attendance
This description is intended to describe the type and level of work being performed by a person assigned to this job. It is not an exhaustive list of all duties and responsibilities of a person so classified. The employee is expected to adhere to all company policies and perform other duties as assigned for the good of the consumers, the program, the department and the agency.

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