Licensing & Credentialing Manager

The Licensing & Credentialing Manager plays a key role in building and maintaining our payer network. This position oversees licensing, credentialing, and provider enrollment processes in line with company policies, industry standards, and regulatory requirements. Responsibilities include securing payer contracts in new and existing markets, ensuring timely enrollment with public and private payers, managing licensing and credentialing activities, and resolving enrollment or billing issues. This role ensures clinicians maintain current credentials and licenses to practice in their specialty.

Essential Functions:

Payer Network Development:

• Lead payer contract procurement from outreach to execution
• Negotiate terms with national and regional payers
• Build and maintain payer relationships across markets
• Monitor and manage contracts through their lifecycle
• Partner with legal and finance to ensure compliance

Data Analysis & Reporting

• Analyze enrollment data to improve processes
• Track contract performance, utilization, quality, and denials
• Provide reports on enrollment, licensing, and credential compliance

Licensing & Credentialing:

• Manage licensing and credentialing activities with third-party partners
• Maintain accurate records, monitor expirations, and oversee renewals
• Ensure compliance with all laws, regulations, and accreditation standards
• Implement efficient procedures to streamline enrollment
• Serve as the main contact for licensing, credentialing, and enrollment inquiries
• Actively participate in Credentialing Committee discussions

Qualifications:

• Bachelor’s degree in Business, Healthcare Administration, or related field
• 2–4 years of experience in payer contracting, ideally in telehealth
• Skilled in negotiating and managing contracts across multiple payers
• Strong knowledge of payer fee schedules, credentialing requirements, and regulatory bodies (CMS, NCQA, etc.)
• Experience with credentialing software or third-party vendors
• Ability to maintain HIPAA compliance and manage confidential information