Assistant Manager

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.