Account Manager (Credentialing Specialist) | ASAP | Hybrid Setup

Infinit-O; Pasay; On-site; PHP 360,000 - 600,000; Full time

Benefits offered by this job

Devices provided

Job summary

Infinit-O is seeking an Account Manager, Credentialing to oversee end-to-end provider enrollment and primary source verification for medical and behavioral health groups. You will serve as the primary contact for providers, drive contract negotiations, and build provider groups linked to insurance contracts.

You will manage CAQH ProView data, navigate payer portals, and coordinate state enrollments while maintaining timely updates with clients and payer timelines.

Qualifications

• Minimum of 3+ years in a credentialing specialist or manager role.
• Proficient in Behavioral Health (LMFT, NP) and Medical (MD) credentialing.
• Deep knowledge of Medicare forms (CMS-855B) and PECOS.
• Experience with state-specific Medicaid applications (e.g., PAVE for California).

Responsibilities

• Full-Cycle Provider Enrollment & Contracting.
• System & Portal Management using CAQH ProView, Availity, PECOS, NPPES.
• Client Relationship Management with regular credentialing updates and issue resolution.

Skills

Credentialing

Provider enrollment

Client management

Communication

Organization

Tools

PECOS

CMS-855B

Availity

Excel

Job description

Infinit-O is the trusted, customer-centric, and sustainable leader in Business Process Optimization. We empower finance and healthcare organizations to thrive in a digital-first world by combining specialized industry expertise and innovative technology for 20 years.

We navigate complex industry landscapes to drive transformative outcomes, helping businesses streamline operations, enhance customer experience, and achieve sustainable growth backed by a world-class Net Promoter Score of 75. Our approach combines operational efficiency with a human-centered ethos, ensuring sustainable value creation for our clients and team members.

As a Certified B Corporation, Infinit-O is committed to the highest standards of social and environmental performance, accountability, and transparency. We embed these values into every aspect of our operations- aligning business success with a positive impact on our clients, people, and communities.

Our commitment to Diversity, Equity, and Inclusion (DEI) is integral to our mission. We believe that building inclusive, equitable teams is not only the right thing to do - it is also essential for driving innovation and better business outcomes. We actively promote equal opportunity through inclusive hiring practices, continuous learning programs, and regular equity assessments to ensure a fair and empowering workplace for all.

About the Role

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.

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.

Requirements

• 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 new processes.
• Organization: Mastery of tools like Excel/Google Sheets for tracking hundreds of providers across various stages (e.g., color-coding by status).

Devices will be provided to successful candidates