US Health Insurance Credentialing Manager

WELLNITE

About the Role

US Credentialing Manager

The ideal candidate is proactive, analytical, and capable of handling multiple priorities with precision and professionalism.

Key Responsibilities

Credentialing & Enrollment

• Manage and oversee end-to-end

  US healthcare credentialing

  , including CAQH maintenance, NPI, PECOS, Medicare/Medicaid enrollment, commercial insurance enrollment, and provider updates.
• Ensure timely submission, follow-up, and approval of credentialing applications.
• Maintain strict compliance with NCQA, CMS, and payer-specific guidelines.
• Audit credentialing files to ensure accuracy and regulatory compliance.

Team Leadership & Operations

• Lead, mentor, and manage a credentialing team to ensure high performance and timely deliverables.
• Establish processes, workflows, and SLAs for team efficiency.
• Conduct team training on payer policies, documentation requirements, and regulatory updates.
• Monitor team workload and performance metrics to ensure operational excellence.

Coordination & Communication

• Serve as the primary point of contact for providers, payers, and internal departments.
• Maintain clear communication regarding provider status, application timelines, and credentialing updates.
• Handle escalations and resolve credentialing-related issues promptly.

Rate Negotiation & Contract Management

• Negotiate

  reimbursement rates

  with US insurance payers.
• Review and manage payer contracts, amendments, fee schedules, and participation agreements.
• Build strong payer relationships to support credentialing and contracting success.

Required Skills & Qualifications

Technical Credentialing Skills

• Strong understanding of US healthcare systems, credentialing standards, and payer requirements.
• Expertise in CAQH, NPPES, PECOS, Availity, OneHealthPort, and payer portals.
• Knowledge of Medicare/Medicaid regulations and commercial payer processes.
• Experience with revalidations, reappointments, and credentialing audits.

Management & Organizational Skills

• Exceptional organizational skills with an ability to manage large volumes of data and documents.
• Proven ability to lead, train, and manage a team in a fast-paced environment.
• Strong multitasking abilities with a commitment to accuracy and deadlines.

Negotiation & Communication Skills

• Strong negotiation skills for rate discussions and payer contracting.
• Excellent verbal and written communication skills when working with US-based clients and payers.
• Ability to handle sensitive provider information with confidentiality.

Tools & Software Knowledge

• Credentialing and RCM software (e.g., Modio, CredSimple, VerityStream, Kareo, Athena, etc.)
• MS Office Suite, especially Excel
• CRM or project management tools (Asana, Trello, Jira)

Preferred Qualifications

• 48 years of experience in US healthcare credentialing
• Prior experience managing a credentialing team
• Familiarity with provider onboarding processes
• Strong analytical and reporting skills

What We Offer

• Competitive salary package