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Credentialing Account Manager

Company Overview

Health Prime was created by Physicians to take the burden off Physician practices so they can get back to what matters most – their patients. We have a proven track record of proactively assisting physicians and their practices to provide highest quality healthcare to the communities. We do this through our extensive experience, deep expertise & proprietary technology stack across the entire healthcare revenue cycle.

Our values are at the core of everything we do – customer success, integrity, innovation, teamwork, and professional development. 

Health Prime operates globally with presence in the United States, India, and Costa Rica. In India, we have strategic delivery centers in Mumbai and Bangalore. We deliver multi-specialty services to our clients from these locations. 

Position Overview

The Credentialing Account Manager is responsible for administrative and technical duties requiring attention to detail in the enrollment and re-enrollment with all payor contracts and hospital application submissions that our Health Prime clients are contracted with, or has an agreement with, for the reimbursement of healthcare services.  

This individual will serve as the primary points of contact for all day-to-day activities throughout all phases of the provider enrollments process; identifying, initiating, monitoring, and maintaining enrollment requirements set forth by payers, payer intermediaries, clearinghouses, and hospital application submissions. 

A successful candidate in this role will be customer centric, have experience managing multiple projects, required tasks, monitor progress, and providing updates accordingly. 

Essential Duties and Responsibilities:

•    Maintain individual provider files and group information to include up to date information needed to complete the required government and commercial payer enrollment applications.
•    Maintain internal trackers to ensure all information is accurate and logins are available and legible.
•    Update each provider’s CAQH database file timely according to the schedule published by CMS.
•    Complete revalidation requests issued by government payers.
•    Complete provider enrollment applications to add providers to commercial payers, Medicare, and Medicaid.
•    Enroll new provider and complete re-enrollment applications for commercial payers.
•    Credential/ approve new and existing groups with government and commercial insurance plans.
•    Interact professionally with client and health plan representatives to provide appropriate and timely responses to questions and concerns regarding provider enrollment applications.
•    Retain all records related to completed provider enrollment applications.
•    Audit, monitor and maintain provider profiles across all provider enrollments platforms (Modio, Intellisoft, etc.).
•    Keep the clients updated on the progress of their application and scope of work.
•    Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
•    Other duties as assigned.

Required Skills / Attributes:

•    Excellent computer skills including Excel, Word, and Microsoft Office.
•    Detail oriented with above average organizational skills.
•    Plans and prioritizes to meet deadlines.
•    Excellent customer service skills; communicates clearly and effectively.
•    Proven ability to effectively manage and organize assigned tasks and workflow.


•    This role typically requires a bachelor’s degree. In lieu of a degree, a comparable combination of education and experience (including military service) may be considered.
•    Working knowledge of specific application requirements for Centers for Medicare & Medicaid Services (CMS), State Medicaid and all third-party payers including pre-requisites, forms required, form completion requirements, supporting documentation such as Drug Enforcement Agency Number (DEA), Curriculum Vitae (CV), and regulations.
•    Working knowledge of physician HIPAA Privacy & Security policies and procedures.
•    1-3 years minimum experience in provider enrollment with specific payor(s) subject matter expertise.
•    1-3 years’ experience within client facing roles, RCM technology, process improvement, and/or workflow implementations.
•    Strong oral, written, and interpersonal communication skills, sufficient for both internal and customer-facing communications.
•    Proven ability to effectively manage and organize assigned tasks and workflow.

Physical Requirements:

•    Prolonged periods sitting at a desk and working on a computer.
•    Must be able to lift up to 15 pounds.

Health Prime is an Equal Opportunity Employer

To learn more about Health Prime please visit –

Job Location: Remote US