Job Description
OVERVIEW
The Credentialing Manager owns end-to-end governance of the provider credentialing function, spanning internal intake and outsourced vendor operations. Internal credentialing intake is performed by dedicated coordinators/analysts, while day-to-day credentialing operations application preparation, payer submission, follow-up, and re-credentialing processing are executed by contracted vendor resources. This role may require hands-on credentialing operations while owning oversight, quality assurance, and reporting across the entire credentialing lifecycle, ensuring vendor performance meets contractual, compliance, and client service standards. The Credentialing Manager is the primary escalation point for credentialing issues, the owner of vendor accountability metrics, and the connective layer between internal intake, vendor operations, compliance, and client-facing leadership.
CORE RESPONSIBILITIES
• Own internal intake process – ensure current-provider and re-credentialing packets are complete, accurate, and on schedule before vendor handoff.
• Set and enforce data-quality standards for intake (CAQH, licensure, malpractice, education/training, payer requirements) so vendors receive submission-ready files.
• Manage the intake team – workload distribution, training, and performance coaching for coordinators/analysts.
• Serve as handoff gatekeeper, resolving discrepancies between internal intake and vendor operations before they cause delays.
• Own day-to-day and strategic vendor oversight for all credentialing operations (submissions, payer follow-up, enrollment tracking, re-credentialing/revalidation), including SOW/SLA accountability and governance cadences (syncs, QBRs).
• Manage escalations and root-cause resolution for stalled enrollments, payer rejections, CMS I&A;/surrogacy issues, and systemic vendor errors, and support vendor transitions/onboarding/offboarding.
• Administer the QA program – audit vendor work for accuracy, timeliness
📌 RCM Manager Credentialing (Pune)
🏢 Veradigm
📍 Pune