Payer Credentialing Manager

About the Company

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.

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.

Requirements

• Bachelor’s degree in healthcare administration, business, or related field
• 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
• Hands-on experience with payer credentialing systems (e.g., CAQH, Medallion)
• Strong knowledge of databases and Microsoft Office applications

Benefits

• Competitive salary
• 401(k) with employer match
• Health, dental, and vision insurance
• PTO + paid holidays
• Life insurance coverage

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