RCM Manager Credentialing

Allscripts(India) LLP, ultimately a subsidiary of Altera Digital Health Inc.,[Altera India]; Pune District; Hybrid; INR 2,500,000 - 4,000,000; Full time

Job summary

Allscripts(India) LLP is seeking a Credentialing Manager to govern provider credentialing end-to-end, coordinating internal intake with outsourced vendor operations. The role oversees intake, submissions, payer follow-up, and re-credentialing, ensuring data quality, timelines, and compliance with NCQA and CMS standards.

You will lead vendor oversight, escalation resolution, and performance reporting, acting as a bridge between internal teams, vendors, Compliance, and leadership.

Qualifications

• Bachelor's degree in healthcare administration, business, or related field or equivalent professional experience.
• 8+ years of progressive credentialing or payer enrollment experience including 3+ years in lead/vendor-oversight roles.
• Experience managing outsourced credentialing operations, including SLA management and vendor governance.
• Experience running a QA program for credentialing or back-office operations.

Responsibilities

• Own internal intake process and ensure complete, accurate provider packets before vendor handoff.
• Set data-quality standards for intake so vendors receive submission-ready files.
• Manage intake team workload, training, and performance coaching.
• Resolve discrepancies between internal intake and vendor operations to avoid delays.
• Oversee day-to-day and strategic vendor oversight for credentialing activities and governance cadences.
• Handle escalations for stalled enrollments and vendor errors; support vendor transitions.
• Administer QA program, audit vendor work, and drive remediation plans.
• Collaborate with Compliance to meet NCQA, CMS, and payer standards across internal and vendor work.
• Own performance reporting and present results to leadership.
• Act as liaison to Operations, Client Services, Compliance, and leadership; shape vendor strategy.

Skills

Vendor governance

SLA management

QA program design

Data analysis

Stakeholder communication

Analytical thinking

Education

Bachelor's degree

Tools

CAQH Portal

PECOS Portal

NPPES

Job description

Job Summary

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 new-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 IA/surrogacy issues, and systemic vendor errors, and support vendor transitions / onboarding / offboarding.
• Administer the QA program - audit vendor work for accuracy, timeliness, and completeness; identify and trend error patterns; own remediation and corrective-action plans.
• Partner with Compliance to ensure credentialing practices meet NCQA, CMS, and payer-specific standards across internal and vendor work.
• Own performance reporting - maintain the credentialing scorecard (cycle time, turnaround, first-pass rate, backlog aging, SLA attainment), exception tracking, and present results/audit-ready records to leadership.
• Act as primary stakeholder liaison - communicate credentialing status, risk, and vendor performance to Operations, Client Services, Compliance, and leadership, and partner on vendor strategy/capacity planning.

Required Qualifications

• Bachelor's degree in healthcare administration, business, or a related field or equivalent professional experience.
• 8+ years of progressive experience in provider credentialing or payer enrollment, including 3+ years in a lead, management or vendor-oversight capacity.
• Demonstrated experience managing outsourced/BPO credentialing operations, including SLA management, vendor governance, and escalation resolution.
• Experience running a QA program for credentialing or a comparable back-office operational function.

Preferred Qualifications

• Certified Provider Credentialing Enrollment Specialist or equivalent payer-enrollment credentials.
• Strong working knowledge of CAQH, PECOS, CMS IA, NPPES, and payer-specific enrollment portals and requirements.
• Proven vendor management skills: SLA design and enforcement, performance score carding, contract-aligned accountability, and difficult-conversation escalation.
• Strong QA program design and audit skills, with the ability to identify systemic issues versus one-off errors and drive root-cause corrective action.
• Analytical proficiency with Excel and reporting tools; comfort building and maintaining scorecards, trackers, and dashboards from vendor data exports.
• Excellent stakeholder communication skills, with the ability to represent credentialing performance and risk to senior and client-facing leadership.
• Sound understanding of NCQA, CMS, and payer credentialing compliance standards.
• Ability to manage multiple vendors, client books, and concurrent escalations in a fast-paced, metrics-driven environment.

Disclaimer: This job posting has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.