Credentialing Manager, RCMS

Overview

Key Responsibilities

• Manage day-to-day operations of the credentialing team in India, ensuring timely and accurate completion of credentialing and re-credentialing activities.
• Supervise staff, provide coaching, and ensure adherence to standard operating procedures and best practices.
• Optimize tools, technology, and credentialing systems to drive efficiency, accuracy, and a positive customer experience.
• Partner with the U.S. credentialing and operations leadership to align on processes, KPIs, and customer strategies.
• Ensure compliance with payer requirements, NCQA standards, and other regulatory guidelines.
• Oversee provider enrollment activities, including new applications, revalidations, and updates.
• Monitor credentialing performance metrics (e.g., turnaround time, accuracy, payer approval rates) and report progress to leadership.
• Identify opportunities for process automation and efficiency improvements.
• Act as point of escalation for complex credentialing issues or customer concerns.
• Collaborate with Revenue Cycle, Customer Success, and Implementation teams to ensure credentialing supports overall service delivery.
• Assist in developing training programs and documentation to standardize credentialing practices across the team.

Success Metrics

• Timely completion of credentialing and re-credentialing activities.
• High accuracy and compliance with payer/regulatory requirements.
• Optimized tools and systems supporting efficiency and customer satisfaction.
• Reduced credentialing-related delays impacting customer revenue.
• Positive customer feedback and increased retention linked to credentialing support.
• Efficient and scalable credentialing processes supported by automation and standardization.

Qualifications

• Bachelors degree in business administration, Healthcare Management, or related field.
• 4+ years of experience in provider credentialing or enrollment, with at least 2 years in a leadership/supervisory role.
• Strong understanding of payer credentialing requirements, NCQA standards, and healthcare compliance.
• Familiarity with behavioral health provider credentialing preferred.
• Experience with credentialing software and EHR platforms (CareLogic, Credible, or InSync a plus).
• Strong leadership and people management skills with ability to mentor and develop staff.
• Excellent communication, problem-solving, and organizational skills and ability to collaborate across geographies and time zones.