Manager - Provider Enrollment & Credentialing

1 day ago

SAS Nagar, India Knack RCM Full time

About the Role: The Manager – Provider Enrollment & Credentialing will be responsible for overseeing the end-to-end provider enrollment, credentialing, and re-credentialing processes for healthcare providers across multiple payers. This role involves managing a team, ensuring compliance with payer and regulatory requirements, maintaining strong client relationships, and driving process efficiency and quality across all credentialing operations. Location: Mohali (On-site) Key Responsibilities: Team & Operations Management - Lead and mentor the Credentialing and Provider Enrollment team, ensuring productivity, accuracy, and adherence to SLAs. - Oversee day-to-day operations related to CAQH management, payer applications, NPI, and Medicare/Medicaid enrollments. - Manage re-credentialing, demographic updates, and enrollment follow-ups with payers. - Ensure completion of applications, verifications, and documentation within defined timelines. Process Improvement & Compliance - Establish and maintain process documentation, SOPs, and performance trackers. - Monitor quality and turnaround time (TAT) and implement corrective actions when required. - Ensure all credentialing processes comply with NCQA, CMS, and payer-specific regulations. - Identify process gaps and recommend automation or standardization opportunities. Client & Stakeholder Communication - Serve as a primary point of contact for clients, addressing escalations and ensuring satisfaction. - Collaborate with cross-functional departments (Operations, IT, HR, Quality) to support smooth functioning of credentialing workflows. - Conduct regular business review meetings (internal & client-facing) to present performance and improvement metrics. Reporting & Metrics - Track and report KPIs including application submission, approval rates, and error percentages. - Generate weekly/monthly performance reports and share insights for leadership review. Qualifications: - Bachelor's degree in Healthcare, Business Administration, or related field (Master's preferred). - Minimum 8 years of RCM experience with at least 3 years in credentialing management. - Prior experience in client handling and process transition will be an added advantage. Why Join Knack RCM: - Work with one of the most trusted and established names in the RCM industry. - Opportunity to lead a growing credentialing vertical with strong client exposure. - Transparent, performance-driven environment with structured growth path. - Employee-friendly culture that values skill, ownership, and innovation.

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