Credentialing Manager

About the role

We are seeking a Credentialing Manager to serve as the technical authority for our credentialing operations and act as a client‑facing expert on prospect and customer calls. You will handle complex enrollment applications, validate audit findings, and support the sales team throughout the sales cycle.

Key responsibilities

• Submit, manage, and follow up on provider enrollment applications across Medicare (PECOS), Medicaid, commercial payers, and managed care organizations.
• Build and maintain CAQH ProView profiles, handle re‑attestations, and resolve data integrity issues.
• Manage NPI Type 1 (individual) and Type 2 (group) registrations through NPPES.
• Conduct in‑network contracting, fee‑schedule review, and panel monitoring.
• Lead weekly payer follow‑up calls and escalations during US business hours.
• Validate credentialing audit findings in the internal audit application (CredReady) before delivery.
• Join audit‑delivery and closing calls with prospects, answering technical questions and establishing credibility.
• Support SDRs in real‑time on calls, providing technical follow‑ups and payer‑specific clarifications.
• Develop and maintain a state‑by‑state, payer‑by‑payer credentialing playbook.
• Train SDRs on credentialing fundamentals and identify operational improvements.

Required profile

• Minimum 8 years of US healthcare credentialing and payer enrollment experience, preferably in a Pakistani RCM/medical billing firm serving US clients.
• Hands‑on expertise with CAQH ProView, PECOS, NPPES, and major payer portals (Availity, OneHealthPort, etc.).
• Deep experience with major commercial payers such as UnitedHealthcare, Aetna, Cigna, Humana, Anthem, BCBS, and Centene/Ambetter.
• Strong Medicare Part B enrollment experience across multiple MAC jurisdictions.
• Experience with Medicaid and managed‑care organization enrollment in multiple states.
• Credentialing experience across multiple specialties; behavioral health and group practice experience preferred.

Required skills

• CAQH ProView
• PECOS
• NPPES
• Availity portal
• OneHealthPort
• CredReady audit application
• Medicare Part B enrollment
• Medicaid and MCO enrollment