Payer Credentialing Manager
Position Type: Full-time
Compensation: TBA
Company Overview
Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer multispecialty physician services, telemedicine, remote patient monitoring, and more.
Job Summary
We’re seeking a Payer Credentialing Manager to lead payer credentialing and re-credentialing processes for healthcare providers while ensuring compliance with accreditation standards, regulatory requirements, and organizational policies. This role includes oversight of payer enrollments, managing the payer credentialing team, maintaining data accuracy, and streamlining provider onboarding to reduce risk and support patient safety.
Shift Structure
Key Responsibilities
- Oversee the processing of initial payer applications for health professionals, ensuring compliance with national accreditation standards and state/federal regulations.
- Maintain and manage payer credentialing databases and electronic records, ensuring accuracy, confidentiality, and audit readiness.
- Liaison with medical staff leadership, payers, licensure boards, and regulatory agencies to resolve credentialing issues promptly.
- Supervise payer credentialing staff by coordinating workloads, providing training, monitoring performance, and ensuring quality outcomes.
- Conduct regular audits of payer credentialing processes to identify gaps, implement corrective actions, and drive continuous improvement.
Qualifications
Education
- Bachelor’s degree in healthcare administration, business, or related field.
Experience
- Minimum of 3 years in payer credentialing or healthcare administration.
- 1–3 years in a supervisory or managerial role.
- Demonstrated experience with payer enrollment processes.
Technical Proficiency/Skills
- Hands-on experience with payer credentialing systems (e.g., CAQH, Medallion).
- Strong knowledge of databases and Microsoft Office applications (Excel, Access, Word).
- Strong organizational skills, attention to detail, communication, problem –solving, and knowledge of regulatory guidelines.
Compensation and Benefits
- Competitive salary
- 401(k) with employer match
- Health, dental, and vision insurance
- PTO + paid holidays
- Life insurance coverage
- Remote flexibility with a national legal scope
Employee must be able to perform the essential functions of this position satisfactorily, with or without a reasonable accommodation. Employer retains the right to change or assign other duties to this position.
#LI-Remote
#LI-JD1#IND
#TSA2
United States
Philippines