LSMA Management, Inc. · 4 days ago
Credentialing Manager
San Bernardino, CA
Full-time
Onsite
Mid, Senior Level
3+ years expLSMA Management, Inc. is seeking a Credentialing Manager responsible for overseeing the provider credentialing and recredentialing processes. This role involves ensuring compliance with regulatory standards and leading credentialing operations within the organization, while collaborating with various internal and external stakeholders.
Government Administration
Responsibilities
Lead and manage all aspects of provider credentialing, recredentialing, and privileging for physicians, allied health professionals, and facilities
Ensure compliance with NCQA, CMS, DMHC, DHCS, and health plan-specific requirements, as well as internal organizational policies and procedures
Oversee primary source verification, file completeness, and adherence to credentialing timelines
Maintain current and accurate credentialing data across systems (e.g., CAQH, MD-Staff, VerityStream/CredentialStream, Modio, or other platforms)
Monitor expiring credentials (licenses, DEA, malpractice insurance, board certification, etc.) and ensure timely re-verification
Oversee the preparation, accuracy, and submission of credentialing and roster files to contracted health plans and delegated entities
Serve as the primary point of contact for delegated credentialing audits, regulatory reviews, and health plan oversight visits
Ensure delegated activities meet NCQA, DHCS, Medicare Advantage, and health plan delegation requirements
Maintain delegated credentialing policies, audit tools, dashboards, and corrective action plans when necessary
Manage the Credentialing Committee process, including preparing agendas, presenting files, creating minutes, documenting decisions, and following up on action items
Ensure committee processes meet organizational bylaws, regulatory requirements, and accreditation standards
Oversee payor enrollment and revalidation with Medicare (PECOS), Medi-Cal (PAVE), NPPES, CAQH, and commercial plans to support timely provider onboarding
Collaborate with Revenue Cycle, Contracting, Provider Relations, and Operations to ensure providers are loaded correctly and activated on schedule
Support provider directory accuracy and network integrity across all participating health plans
Develop, implement, and monitor credentialing workflows that improve efficiency, accuracy, and turnaround times
Create and maintain SOPs, audit tools, job aids, and training materials for the credentialing department
Track and report key performance metrics (e.g., file completion rates, turnaround times, expirables compliance, payor enrollment delays)
Maintain complete, organized documentation required for internal audits, NCQA surveys, and delegated audits
Partner with Provider Relations, Contracting, Compliance, Quality, HR, IT, and Operations to ensure seamless provider onboarding and offboarding
Support network expansion activities by communicating credentialing requirements and onboarding timelines to leadership and stakeholders
Respond to internal and external credentialing inquiries and assist with escalations from providers, payors, or contracted partners
Supervise and support credentialing staff, providing ongoing training, coaching, mentorship, and performance feedback
Assign and monitor workloads, ensuring timely completion of tasks and accurate processing of provider files
Foster a collaborative, accountable, high-quality team culture focused on compliance and service excellence
Qualification
Required
Bachelor's degree in healthcare administration, business, or related field
Three to five years of credentialing experience in a managed care, IPA, MSO, medical group, or health plan environment
At least one year supervisory or management experience
Knowledge of credentialing standards and regulatory requirements including NCQA, CMS, DMHC, DHCS, Medicare Advantage, and Medi-Cal
Knowledge of primary source verification processes and credentialing file components
Knowledge of delegated credentialing models and health plan delegation requirements
Knowledge of payor enrollment processes (PECOS, PAVE, NPPES, CAQH, commercial plans)
Knowledge of credentialing software platforms and database management
Knowledge of medical staff bylaws, credentialing committee functions, and audit documentation standards
Strong analytical and organizational skills to manage complex data and workflows
Excellent written and verbal communication skills
Proficiency with credentialing and enrollment systems (CAQH, MD-Staff, CredentialStream, Modio)
Strong leadership, training, and coaching skills
High accuracy and attention to detail in reviewing documentation and verifying data
Strong project management and multitasking in a deadline-driven environment
Ability to interpret and apply regulatory and accreditation standards
Ability to maintain confidentiality and handle sensitive provider information
Ability to work collaboratively across departments and with external partners
Ability to prioritize competing tasks and manage high-volume workloads
Ability to problem-solve and propose workflow improvements
Ability to represent the organization professionally during audits and committee meetings
Preferred
CPCS and/or CPMSM certification (NAMSS)
Experience with delegated credentialing and health plan audits
Experience working with contracted provider networks or multi-site medical groups
Company
LSMA Management, Inc.
We’ve seen the stress and toll that poor management takes on practices: the rigid policies, the pressure to prioritize volume over patient relationships and clinical judgment, the operational breakdowns that erode trust.
501-1000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase