The Account Manager, Credentialing is a senior-level specialist responsible for managing the end-to-end provider enrollment and primary source verification process for medical and behavioral health groups. Unlike an assistant, this role involves direct client management, complex contract negotiation, and the ability to build provider groups from the ground up. You will act as a primary point of contact for providers, ensuring they are successfully linked to insurance contracts and maintained in good standing with all relevant payers.

Details:

- Work Setup: Full WFH setup
- Office Address: Gurgaon, India

Key Responsibilities:

Full-Cycle Provider Enrollment & Contracting

- New Group Setup: Facilitate the creation of new medical groups from scratch, including obtaining Tax IDs and group NPIs.
- Contract Acquisition: Manage the process of obtaining and negotiating contracts with commercial payers (e.g., United Healthcare, Cigna, Aetna) and government entities (Medicare/Medicaid).
- Provider Linking: Execute the linking of individual providers to group contracts across multiple states.
- Hospital Privileging: Assist providers with hospital admitting privileges and affiliation applications when required.

System & Portal Management
- CAQH ProView: Create and maintain provider profiles from scratch, ensuring all data summaries, professional liability insurance, and CVs are current and attested every 120 days.
- Payer Portals:



Navigate and utilize various portals including Availity, Optum/Provider Express, NPPES (NPI), and PECOS for application submission and tracking.
- State-Specific Platforms: Manage complex state enrollments, such as California’s PAVE portal and Arizona’s APEP.

Client Relationship Management

- Direct Communication: Provide regular (bi-weekly or monthly) credentialing updates to providers and office managers.
- Expectation Management: Educate clients on payer turnaround times and policies while providing high-touch support to anxious or "high-maintenance" clients.
- Issue Resolution: Collaborate with Accounts Receivable (AR) teams to resolve claims denials related to credentialing or missing CPT codes in contracts.

Minimum Qualifications

- Experience: Minimum of 3+ years in a credentialing specialist or manager role.
- Specialty Knowledge: Proficiency in both Behavioral Health (LMFT, NP) and Medical (MD) credentialing.
- Technical Expertise: In-depth knowledge of Medicare forms (e.g., CMS-855B) and PECOS; Expertise in managing state-specific Medicaid applications (e.g., PAVE for California).
- "Self-Taught" Mindset: A proactive "go-getter" attitude with the ability to research answers independently and teach oneself current processes.
- Organization: Mastery of tools like Excel/Google Sheets for tracking hundreds of providers across various stages (e.g., color-coding by status).

📌 Account Manager (Credentialing) (India)
🏢 Infinit-O
📍 India