Manager, Credentialing and Network Specialist
Zócalo Health
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $110,000 - $120,000 per year
About the role
- Own end-to-end provider credentialing and enrollment across Medicaid, Medicare, Medicare Advantage, and D-SNP payers, including maintenance of CAQH and payer systems, tracking of statuses, renewals, and effective dates to ensure uninterrupted network participation.
- Act as the primary internal coordinator for credentialing across providers, payers, and cross-functional teams, resolving issues and driving timely completion.
- Lead credentialing readiness for new payer launches, expansions, and ongoing payer requirements, ensuring standards and timelines are met to accelerate time-to-revenue and maintain payer trust.
- Partner with Implementation and Operations to confirm credentialing completion prior to handoffs and go-lives.
- Ensure credentialing policies and documentation meet payer and regulatory requirements (e.g., CMS, NCQA, state Medicaid agencies, and payer-specific standards).
- Maintain audit-ready credentialing files and documentation to support payer reviews, compliance checks, and Medicare Advantage/D-SNP oversight.
- Monitor and track clinician licenses, board certifications, and required documentation (as applicable), including renewal workflows and proactive outreach.
- Manage credentialing / eligibility requirements for community-based roles relevant to Medicaid and CalAIM delivery (e.g., CHWs), including certification pathways and ongoing compliance tracking.
- Build and maintain systems that track workforce readiness requirements such as certification status, training completion, supervision needs, and continuing education requirements where applicable.
- Build and continuously improve credentialing infrastructure, including: SOPs and policies/procedures, standardized forms and credentialing packets, onboarding checklists and job aids, tracking systems and dashboards (credentialing status, payer readiness, expirables).
- Identify bottlenecks and implement process improvements to reduce credentialing cycle times and improve readiness accuracy.
- Operate as a trusted cross-functional partner to Payer Partnerships, Implementation, Operations, and Clinical leaders.
- Communicate clearly and proactively when credentialing risks threaten timelines, launches, or payer requirements.
- Create clarity and accountability around credentialing ownership, timelines, and required inputs.
Requirements
- 5+ years of experience in provider credentialing, enrollment, or healthcare network operations
- Hands-on experience managing CAQH profiles
- Experience credentialing providers across Medicaid and Medicare (Medicare Advantage and/or D-SNP highly preferred)
- Strong operational judgment, attention to detail, and comfort owning complex workflows end-to-end
- Proven ability to build repeatable systems (trackers, SOPs, documentation, workflows) in a scaling environment
- Prior experience supporting payer audits or readiness assessments
- Strong communication skills and ability to work across multiple teams and priorities.
Benefits
- Competitive salary: $110k - $120k (depending on experience)
- Equity compensation package
- Comprehensive benefits including medical, dental, and vision
- 401k
- Flexible PTO policy - take the time you need to recharge
- $1,000 home office stipend
- We provide the equipment needed for this role.
- Opportunity for rapid career progression with plenty of room for personal growth.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
provider credentialingenrollmentCAQH managementMedicaid credentialingMedicare credentialingMedicare AdvantageD-SNPaudit readinessworkflow managementprocess improvement
Soft Skills
operational judgmentattention to detailcommunicationcross-functional collaborationproblem-solvingaccountabilitytimelinessproactive outreachleadershiporganizational skills