Team Lead - Credentialing

The Credentialing Team Lead will manage and supervise a team of credentialing specialists to ensure timely and accurate credentialing of healthcare providers. This individual will play a key role in ensuring that all healthcare providers, including physicians, nurses, and allied health professionals, meet the necessary legal and regulatory requirements to be part of the organization's network. The role involves overseeing day-to-day credentialing operations, ensuring compliance with regulatory standards, and maintaining accurate and up-to-date records.

Key Responsibilities:

Lead, supervise, and mentor a team of credentialing specialists, ensuring adherence to credentialing policies and procedures.
Manage and coordinate the process of credentialing new providers, ensuring all documentation is completed accurately and in a timely manner.
Ensure compliance with federal and state regulations, including NCQA (National Committee for Quality Assurance), URAC (Utilization Review Accreditation Commission), and other relevant standards.
Review provider credentialing files for completeness and accuracy; verify licensure, certifications, and malpractice insurance, and ensure all necessary documentation is provided.
Act as the main point of contact for internal departments and external organizations regarding credentialing matters.
Coordinate with physicians, providers, and healthcare facilities to gather necessary documents for credentialing and re-credentialing.
Monitor the team’s progress, ensuring that credentialing requests are processed within specified timelines and quality standards.
Prepare and submit credentialing applications to insurance carriers and other third-party organizations.
Maintain accurate records of credentialing files, re-credentialing, and provider status changes in the credentialing database or system.
Conduct audits and ensure compliance with accreditation standards.
Provide training and support to new team members, ensuring they are knowledgeable in credentialing processes and guidelines.
Collaborate with the leadership team to develop and implement process improvements to streamline credentialing workflows and ensure efficiency.

Qualifications:

Bachelor’s degree in healthcare administration, business administration, or a related field (preferred).
Minimum of 3-5 years of experience in credentialing, with at least 2 years in a leadership or supervisory role.
Knowledge of healthcare regulations, compliance standards, and industry best practices for credentialing (e.g., NCQA, URAC).
Familiarity with credentialing software and database systems.
Strong leadership, interpersonal, and communication skills.
Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
Attention to detail and strong organizational skills.
Certification in credentialing (e.g., Certified Provider Credentialing Specialist (CPCS)) is a plus.