Credentialing Manager (RCM)

Job Description

Job Title: Credentialing Manager – Revenue Cycle Management (RCM) Job Summary: We are seeking a highly motivated and experienced Credentialing Manager with 10+ years of experience in Revenue Cycle Management (RCM). This role is critical to ensuring that healthcare providers are properly credentialed, enrolled, and compliant with all regulatory and payer requirements. The ideal candidate will have a strong understanding of credentialing processes, healthcare regulations, payer requirements, and effective team management skills. Key Responsibilities: Manage the end-to-end credentialing process, including initial credentialing, re-credentialing, and enrollment for healthcare providers with insurance payers, Medicare, Medicaid, and other entities. Ensure timely and accurate submission of credentialing applications, supporting documentation, and follow-ups. Monitor credentialing and re-credentialing timelines to avoid gaps in provider eligibility. Maintain compliance with all regulatory, legal, and payer-specific requirements related to credentialing and enrollment.. Conduct periodic audits to ensure accuracy and completeness of credentialing records. Lead, mentor, and manage a team of credentialing specialists to achieve departmental goals. Provide training and guidance on credentialing policies, processes, and best practices. Monitor team performance and implement strategies for continuous improvement. Act as the primary liaison between healthcare providers, payers, and internal stakeholders regarding credentialing and enrollment issues. Resolve provider enrollment issues and escalate concerns as necessary. Communicate updates and changes in credentialing policies and payer requirements to relevant parties. Maintain accurate and up-to-date credentialing records in the credentialing software or database. Generate and present reports on credentialing status, key performance indicators (KPIs), and compliance metrics. * Experience: Minimum of 10 years of experience in credentialing within the Revenue Cycle Management (RCM) or healthcare industry, with at least 2 years in a leadership or management role. Skills: Strong knowledge of credentialing and enrolment processes, payer requirements, and healthcare regulations. Proficiency in credentialing software and systems. Excellent organizational, problem-solving, and multitasking abilities. Strong leadership and team management skills. Effective verbal and written communication skills. Preferred Qualifications: Certification in credentialing (e.g., CPCS or CPMSM) is highly desirable. Experience with RCM operations and understanding of the healthcare revenue cycle. Familiarity with HIPAA, NCQA, and other accreditation standards. Job Type: Full-time Benefits: Food provided Provident Fund Schedule: Monday to Friday Night shift US shift Experience: credentialing: 10 years (Required) Location: Chandigarh, Chandigarh (Required) Work Location: In person