Job Title: Manager Credentialing (US Healthcare)

Department: US Healthcare Operations

Location: Pune

Experience Required: 9-13 Years

Employment Type: Full-Time

Job Summary:

We are seeking a dynamic and experienced Credentialing Manager to oversee and manage end-to-end credentialing function, ensuring seamless provider enrollment, re-credentialing, compliance, and operational excellence across multiple clients and payer networks. Leads credentialing teams, drives strategic initiatives, ensures adherence to regulatory and accreditation standards, manages stakeholder relationships, and delivers high-quality outcomes that support organizational and client objectives

Responsibilities:

- Manage the overall credentialing operations, ensuring compliance with client requirements, payer guidelines, regulatory standards, and organizational policies.
- Oversee provider enrollment, credentialing, re-credentialing, and maintenance processes across insurance networks, hospitals, and healthcare facilities.
- Ensure the accuracy, completeness, and timely submission of provider credentialing applications and supporting documentation.
- Monitor key performance indicators (KPIs), service level agreements (SLAs), turnaround times, quality metrics, and productivity targets across teams.
- Lead, mentor, and develop Team Leaders, Assistant Managers, and credentialing specialists to achieve operational excellence and skilled growth.
- Act as the primary escalation point for complex credentialing, enrollment, compliance, and payer-related issues, ensuring effective resolution and risk mitigation.
- Establish quality control measures and ensure adherence to NCQA, CMS, state, federal, and payer compliance requirements.
- Build and maintain strong relationships with clients, healthcare providers, payers, and internal stakeholders to ensure service delivery excellence.
- Analyze operational data and prepare management reports, dashboards,



and business reviews to provide insights and support decision-making.
- Drive continuous process improvement initiatives, automation opportunities, and best practices to enhance efficiency, accuracy, and client satisfaction.
- Collaborate with cross-functional teams, including Operations, Quality, Compliance, Training, and Client Services, to optimize credentialing workflows.
- Manage workforce planning, resource allocation, capacity management, and succession planning to support business growth and operational requirements.
- Stay updated on changing industry regulations, payer requirements, accreditation standards, and healthcare credentialing trends.
- Support business transitions, client implementations, audits, and strategic projects related to credentialing operations.
- Ensure a culture of accountability, compliance, customer focus, and continuous improvement within the credentialing organization.

Preferred Skills & Qualifications:

- Bachelor's degree in Healthcare Administration, Business Administration, Life Sciences, or a related field.
- 8+ years of experience in US Healthcare Credentialing, with at least 3+ years in a leadership/managerial role.
- Strong knowledge of provider credentialing, enrollment, re-credentialing, payer contracting processes, NCQA standards, and healthcare regulations.
- Proven experience managing large teams, stakeholder relationships, and operational performance metrics.
- Excellent analytical, problem-solving, communication, and people management skills.
- Proficiency in credentialing platforms, provider databases, and MS Office applications.
- Experience in process improvement, project management, and client-facing operations is preferred.

Office Address : R Systems International Limited, 1st & 2nd Floor, Malpani Agile, Baner Road, Pan Card Club Rd, Pune Maharashtra- 411045 Kindly share your resume at [email protected] or connect with me on (phone hidden) for more details.

📌 Manager - Credentialing | U.S Healthcare | Immediate Joiners (Pune)
🏢 R Systems International
📍 Pune