Credentialing Process Manager

WellPower provides you with the support you need to help you develop a career in helping others succeed. We innovate, adapt, and leverage the diverse perspectives of the people on our team and the people we serve in everything we do.

The Credentialing Process Manager is responsible for overseeing and managing the credentialing and credentialing process for healthcare providers to ensure compliance with Medicaid, Medicare, and commercial payer requirements. This involves the development, implementation, and ongoing management of credentialing workflows, ensuring accurate documentation, and streamlining provider credentialing process. They will work closely with internal teams and external stakeholders to ensure providers remain eligible for reimbursement, comply with regulatory standards, and meet all necessary deadlines. This role plays a crucial part in the delivery of accessible, high-quality mental health services, contributing to WellPower’s mission. 

Learn more about WellPower:

Compensation and Benefits:

• $56,000 - $81,000 per year

WellPower is committed to fair and equitable hiring, with salaries based on relevant factors such as experience, education, and licensure. We post defined salary ranges and do not hire outside them. Final salary offers are determined within the range based on qualifications, internal equity, and budget, and are not guaranteed at the top of the range.

All full-time, benefits eligible employees will be eligible for WellPower’s benefits plan. For a full description of benefit offerings, please visit: https://WellPower.org/workplace-of-choice/.

ESSENTIAL JOB FUNCTIONS:

• Possesses advanced knowledge of payer credentialing rules, regulations, and industry best practices, with specific knowledge in Colorado Medicaid, Behavioral Health Administration standards, and non-licensed personnel certification requirements. 
• Designs, manages, and optimizes credentialing workflows to improve efficiency and ensure compliance with Medicaid, Medicare, and other payer networks.
• Monitors and maintains an up-to-date database of provider credentials, certifications, licensure, and insurance information, ensuring accuracy and compliance with regulatory requirements.
• Manages complex credentialing and recredentialing processes, prioritizing tasks and meeting deadlines while ensuring regulatory compliance.
• Ensures that all non-licensed personnel meet the education, training, and certification requirements under Colorado HCPF, Behavioral Health Administration, DORA, and commercial plan
  standards.
• Resolves complex credentialing issues independently, acting as a liaison between providers, payers, and internal teams to address discrepancies and ensure timely resolution.
• Partners with billing and revenue cycle teams to ensure that only credentialed providers deliver billable services, resolving any discrepancies as necessary.
• Leads audits and compliance reviews, implementing process improvements based on findings to optimize the credentialing process. 
• Proactively stays up-to-date on changes to payer requirements and credentialing regulations, adjusting internal processes accordingly to maintain compliance.
• Leads cross-functional teams in credentialing activities, supporting collaboration and process improvements across departments to ensure efficient and accurate credentialing.

REQUIRED QUALIFICATIONS:

• High School Diploma or GED.
• Certified Provider Credentialing Specialist (CPCS).
• 5+ years of experience in credentialing or credentialing process management.

PREFERRED QUALIFICATIONS:

• Associate's degree in healthcare administration, business, or related field.

WORKING CONDITIONS:

This is a full-time, hybrid position with a standard schedule of Monday through Friday during regular business hours. The role includes a combination of remote work and on-site presence at the organization’s main office, as needed to support credentialing activities, meetings, and events.

Why Work at WellPower?
Join a workplace where purpose meets passion!

• Mission-Driven Impact: Be part of meaningful work that transforms lives and strengthens the Denver community.
• Wellness-Focused Culture: Thrive in an organization that prioritizes your self-care and well-being.
• Award-Winning Workplace: Proudly named a Top Workplace by The Denver Post for 11 consecutive years.
• Comprehensive Benefits: Access