ASC Credentialing & Payer Operations Lead

Paycom; Southlake (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

GI Alliance is seeking a Manager for ASC Credentialing and Payer Operations to oversee credentialing and recredentialing processes across ASC locations. You will manage primary source verifications, maintain CAQH/Availity profiles, and coordinate with payer representatives while ensuring HIPAA and regulatory compliance.

The role requires deep knowledge of major payers (Medicare/Medicaid/TRICARE, BCBS, Aetna, Cigna, Humana) and strong organizational and communication skills to support scheduling

Qualifications

• Minimum of five (5) years’ ASC credentialing experience.
• Experience credentialing major payers such as Medicare, Medicaid, Tricare, BCBS, Aetna, Cigna, Humana.
• Knowledge of state and payer specific guidelines.
• Experience creating CAQH, NPI, and PECOS profiles and applications.
• Detail oriented with strong organizational and communication skills.

Responsibilities

• Ensure accurate and timely completion, submission, and follow-up on all credentialing applications with payers and ASC locations.
• Collect primary source verification documentation (licensing, board certifications, professional liability, etc.).
• Maintain credentialing database and notify staff on completion/status for scheduling and billing.
• Prepare and maintain CAQH, and Availity applications for all providers.
• Verify NPI, PECOS, and Texas Medicaid registrations are current and compliant.
• Stay abreast of regulatory requirements and HIPAA privacy regulations.

Skills

ASC credentialing

Payer credentialing

CAQH/NPI/PECOS

HIPAA/privacy

Regulatory compliance

Microsoft Office

Job description

GI Alliance is seeking a Manager for ASC Credentialing and Payer Operations to oversee credentialing and recredentialing processes across ASC locations. You will manage primary source verifications, maintain CAQH/Availity profiles, and coordinate with payer representatives while ensuring HIPAA and regulatory compliance.

The role requires deep knowledge of major payers (Medicare/Medicaid/TRICARE, BCBS, Aetna, Cigna, Humana) and strong organizational and communication skills to support scheduling