Assistant Manager

Credentialing & Enrollment Operations

• Manage end-to-end provider credentialing, re-credentialing, enrollment, and maintenance processes.

• Ensure timely submission of applications to commercial payers, Medicare, Medicaid, and other regulatory bodies.

• Monitor credentialing status and follow up with payers to expedite approvals.

• Maintain accurate credentialing databases and provider records.

• Oversee CAQH profile management, attestations, and data accuracy.

• Track license renewals, board certifications, DEA registrations, NPI updates, malpractice insurance, and other provider documents.

Team Management

• Lead and mentor credentialing specialists and senior credentialing executives.

• Allocate work, monitor productivity, and ensure adherence to SLAs and KPIs.

• Conduct performance reviews and provide regular coaching and feedback.

• Support recruitment, onboarding, and training initiatives.

Client & Stakeholder Management

• Serve as a primary point of contact for clients regarding credentialing matters.

• Provide regular status updates, reports, and escalations to clients and leadership.

• Collaborate with physicians, practice administrators, hospitals, and payer representatives.

• Address and resolve complex credentialing issues and escalations.

Compliance & Quality

• Ensure compliance with NCQA, CMS, state regulations, and payer-specific requirements.

• Implement quality control measures to maintain accuracy and reduce enrollment delays.

• Conduct audits of credentialing files and processes.

• Maintain confidentiality of provider and patient-related information.

Reporting & Process Improvement

• Prepare and analyze operational reports, dashboards, and performance metrics.

• Identify process gaps and implement continuous improvement initiatives.

• Utilize credentialing platforms and workflow management systems effectively.

• Drive automation and standardization across credentialing processes.

Required Qualifications

Education

• Bachelor's degree

Experience

• 6 to 10 years of experience in US Healthcare RCM Credentialing.

• Minimum 2 to 3 years of team handling experience.

• Hands-on experience with provider enrollment, payer credentialing, re-credentialing, and CAQH management.

• Experience working with Medicare, Medicaid, and commercial insurance payers.

Required Skills

Technical Skills

• Knowledge of US healthcare credentialing regulations and payer requirements.

• Familiarity with CAQH, PECOS, NPPES, CMS portals, and payer websites.

• Strong understanding of provider enrollment workflows.

• Advanced proficiency in MS Excel, reporting, and data analysis.

Leadership Skills

• Team leadership and people management.

• Client relationship management.

• Strong problem-solving and decision-making skills.

• Stakeholder management and escalation handling.

Soft Skills

• Excellent verbal and written communication skills.

• Strong organizational and multitasking abilities.

• Attention to detail and accuracy.

• Ability to work in a fast-paced environment with strict deadlines.

Key Performance Indicators (KPIs)

• Provider enrollment turnaround time.

• Credentialing accuracy and quality scores.

• SLA adherence.

• First-pass approval rate.

• Escalation resolution time.

• Team productivity and utilization.

• Client satisfaction scores.