Team Lead - Credentialing (US Healthcare)

Job description

Job Title: Team Leader/AM- Credentialing ((US Healthcare))

Job Description

Responsible for leading the credentialing team to manage provider enrollment, re-credentialing, and compliance with payer and regulatory requirements. Ensures timely and accurate processing, resolves escalations, monitors performance, and drives process efficiency while maintaining high quality and client satisfaction.

Roles & Responsibilities

Supervise and manage the daily operations of the credentialing team, ensuring compliance with client, payer, and regulatory requirements.

Oversee provider enrollment and re-credentialing processes with insurance networks, hospitals, and healthcare facilities.

Review and verify provider documentation for accuracy and completeness before submission.

Monitor turnaround times and ensure timely completion of credentialing and re-credentialing tasks.

Act as the escalation point for complex credentialing issues, working closely with payers and providers to resolve them.

Train, mentor, and monitor team members to maintain quality standards and productivity targets.

Generate and review reports on credentialing status, performance metrics, and compliance.

Coordinate with internal departments, clients, and third parties to ensure smooth credentialing workflows.

Keep updated on payer guidelines, NCQA standards, and healthcare compliance requirements.

Implement process improvements to enhance efficiency, accuracy, and client satisfaction.