Job Summary
We are seeking an experienced and detail-oriented AM Credentialing professional to lead and manage credentialing and enrollment operations. The ideal candidate will have strong hands-on expertise in provider credentialing, payer enrollments, and supervisory experience, ensuring compliance, accuracy, and timely processing across all credentialing activities.
Key Responsibilities
- Oversee and manage end-to-end provider credentialing and re-credentialing processes with commercial and government payers.
- Handle and supervise ERA, EFT, and EDI enrollments, ensuring timely setup and issue resolution.
- Ensure accurate and complete submission of credentialing and enrollment applications to insurance payers.
- Monitor credentialing timelines and proactively follow up with payers to avoid delays or denials.
- Maintain and update provider records in credentialing systems and payer portals.
- Lead, mentor, and supervise the credentialing team, ensuring productivity and quality standards are met.
- Review team performance, provide guidance, and conduct regular quality checks.
- Ensure compliance with payer guidelines, regulatory requirements, and internal SOPs.
- Coordinate with billing, AR, and compliance teams to support seamless revenue cycle operations.
- Prepare and present credentialing status reports to management.
Required Qualifications & Experience
- 7+ years of experience working within a Credentialing Department.
- Strong hands-on experience with ERA, EFT, and EDI enrollment processes.
- Minimum 2 years of experience in a supervisory or lead role.
- In-depth knowledge of provider credentialing, re-credentialing, and payer enrollment processes.
- Strong understanding of payer portals, CAQH, and credentialing compliance standards.
- Excellent organizational, analytical, and problem-solving skills.
- Strong communication and team management abilities.
Preferred Skills
- Experience working with US healthcare payers.
- Familiarity with credentialing software and tracking tools.
- Ability to manage multiple priorities in a fast-paced environment.
- High attention to detail with strong documentation skills.
Employee Benefits
- Competitive salary package
- Fuel card
- Annual leaves
- Health insurance (as per company policy)
- Employee recognition
- Performance-based promotions
- Collaborative and supportive work environment