Manager, ASC Credentialing

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

POSITION PURPOSEThe Manager, ASC Credentialing and Payer Operations, is responsible for the oversight of the ASC facility credentialing and recredentialing application process with all health plans. This position is also responsible for ensuring compliance with credentialing guidelines and understanding the credentialing processes for each of the health plans with which GI Alliance is contracted.ESSENTIAL DUTIES AND RESPONSIBILITIESEnsure accurate and timely completion, submission, and follow-up on all outstanding credentialing/recredentialing applications with payers and ASC locations.Collect primary source verification documentation for initial credentialing, including licensing, board certifications, proof of professional liability insurance, and other necessary documents.Establish and maintain positive working relationships with payer representatives, ASC medical staff, internal departments, and providers.Maintain credentialing database and ensure information is up to date at all times.Notify staff upon completion of provider credentialing and plan participation status for scheduling and billing purposes.Prepare and maintain Standardized Credentialing Application, CAQH, and Availity for all providers.Complete NPPES (NPI), PECOS (CMS), and Texas Medicaid applications.Verify that all ASC credentialing requirements are met.Responsible for monthly submission of provider roster to health plans and timely communication of group additions, changes, and terminations.Stay abreast of regulatory requirements.Adhere to HIPAA privacy regulations.Perform other duties as assigned.KEY COMPETENCIESExperience in ASC and individual provider credentialingExperience in credentialing of major payers such as Medicare, Medicaid, Tricare, BCBS, Aetna, Cigna, Humana, and other commercial and managed plansKnowledge of state and payer specific guidelinesExperience in creating CAQH, NPI, and PECOS profiles and applicationsDetail oriented and capable of exploring innovative solutions to solve complex problemsAbility to work independently and maintain a positive attitudeAbility to manage multiple and simultaneous responsibilitiesAbility to maintain confidentiality of all medical, financial, and legal informationAbility to complete work assignments accurately and in a timely mannerAbility to communicate effectively, with excellent verbal and written communication and customer relation skillsStrong organizational skillsQUALIFICATIONSMinimum of five (5) years’ ASC credentialing experienceProficiency with computer systems and Microsoft Office (Word & Excel) required