Credentialing Manager

About the Company

We are hiring experienced Credentialing & Enrollment Managers / Team Leads who can handle the entire process managing a team of Credentialing Specialists, along with enrolling healthcare providers with insurance companies. This is a permanent work-from-home role and requires strong attention to detail, good communication, and the ability to manage multiple applications independently.

About the Role

Manage end-to-end provider credentialing and insurance enrollment for individual and group providers.

Responsibilities

• Submit and track enrollment applications across all US states.
• Team Leadership: Guiding a team of credentialing specialists, tracking turnaround times (TAT), and solving complex insurance denial escalations.
• System Knowledge: Expert-level familiarity with PECOS, CAQH, and specific Revenue Cycle Management (RCM) tools.
• Attention to Detail: Tracking expiration dates for numerous documents simultaneously without error.
• File Letters of Interest (LOIs) and follow up with insurance payers via calls and emails.
• Work with private insurance, Medicare, Medicaid, Medicaid MCOs, and Medicare Advantage plans.
• Maintain and update provider profiles on portals like:
• CAQH
• PECOS
• Availity
• Navinet
• NPPES
• Apply for and renew provider licenses such as:
• Professional licenses
• DEA
• Controlled Substance licenses
• Ensure provider information and documents are always accurate and up to date.
• Regularly update clients on application status and ensure providers remain active with payers.
• Work independently while staying highly engaged with the remote team.

Qualifications

• Minimum 6-8 years of hands-on experience in provider credentialing and enrollment.
• At least 2 years of experience as a Credentialing Manager / Team Lead

Required Skills

• Strong understanding of documents required for individual and group enrollments.
• Proven experience handling payer communication and follow-ups.
• Comfortable managing multiple applications with accuracy and deadlines.
• Excellent organization and time-management skills.
• Strong written and verbal communication skills for remote work.