Medical Credentialing Manager

AMS Solutions; Oregon; Hybrid; USD 110,000 - 150,000; Full time

Benefits offered by this job

Remote work

Long-tenured team

Growth opportunities

Job summary

AMS Solutions is a Dallas-based medical billing and revenue cycle management company seeking a Medical Credentialing Manager to lead the credentialing team and own enrollment quality across clients nationwide. You will be the primary contact for credentialing clients and partner with our sales team to scope and onboard new accounts.

This is a full-time, fully remote role open to U.S. candidates and reports to the Operations Manager.

Qualifications

• 5+ years of provider credentialing and payer enrollment experience.
• 2+ years leading or supervising a credentialing team.
• Deep working knowledge of CAQH, PECOS, Medicaid enrollment and payer contracting.

Responsibilities

• Lead day-to-day work of the credentialing team: assign cases, set turnaround expectations, review work, and coach teammates.
• Personally manage a caseload of enrollments with commercial payers, Medicare PECOS, and Medicaid.
• Maintain CAQH profiles, attestations, provider registrations, and provider files.
• Serve as the primary contact for credentialing clients and provide weekly status updates.
• Collaborate with sales to scope proposals and onboard new clients.
• Coordinate with billing to ensure providers are linked under contracts and claims go out accurately.

Skills

Credentialing experience

Payer enrollment

Team leadership

CAQH/PECOS knowledge

Billing/revenue cycle understanding

Communication

Detail-oriented

Multistate enrollment

Education

CPCS or CPMSM certification

Tools

Credentialing software

Microsoft 365

Job description

About AMS Solutions

AMS Solutions is a Dallas-based medical billing and revenue cycle management company that has served physician practices since 1992. Our in-house team handles billing, coding, credentialing and payer enrollment for specialty practices across the country, and we are growing our credentialing service line.

Position Overview

The Medical Credentialing Manager leads AMS's credentialing and payer enrollment team while carrying a caseload of their own. You will own the quality and turnaround of every enrollment we manage for our clients, serve as the primary point of contact for credentialing clients, and partner with our sales team to scope and onboard new accounts. This role is for someone who knows the enrollment process cold and is ready to run a team. This is a full-time, fully remote position open to candidates in the United States, reporting to our Operations Manager.

Key Responsibilities

• Lead the day-to-day work of the credentialing team: assign and prioritize cases, set turnaround expectations, review work for accuracy, and coach team members
• Personally manage a caseload of initial enrollments, recredentialing and revalidations with commercial payers, Medicare (PECOS) and Medicaid
• Maintain CAQH profiles and attestations, provider portal registrations, and provider files (licenses, DEA, malpractice expirations)
• Support provider licensing applications and hospital privileging as needed
• Serve as the primary contact for credentialing clients; deliver weekly status updates and resolve escalations
• Follow up with payers until participation is confirmed and keep enrollment tracking current and accurate
• Partner with sales to scope credentialing proposals, confirm payer lists, and onboard new clients
• Coordinate with the billing team so new providers are linked under the group contracts and claims can go out cleanly
• Identify process gaps and improve team workflows, templates and tracking tools

Skills and Qualifications

• 5+ years of provider credentialing and payer enrollment experience; 2+ years leading or supervising a credentialing team
• Deep working knowledge of CAQH, PECOS, Medicaid enrollment, commercial payer contracting and revalidation cycles
• Experience with multiple specialties and multi-state enrollment; familiarity with hospital privileging and state licensing a plus
• Strong understanding of how credentialing affects billing and revenue cycle
• Excellent written and verbal communication; comfortable leading client calls and handling sensitive information confidentially
• Highly organized with strong follow-through and attention to detail
• Proficient with credentialing software and Microsoft 365; CPCS or CPMSM certification is a plus
• Must be authorized to work in the United States

What We Offer

• Remote work, a long-tenured team, and the chance to shape a growing service line at a company that has been in this business for over 30 years.