Credentialing Team Lead

Description

The Credentialing Team Lead oversees and manages the entire credentialing process for healthcare providers, ensuring compliance with all regulations and accreditation standards. This role leads, supports, and develops the credentialing team, while maintaining accurate and timely completion of all credentialing activities. The Team Lead also develops and maintains credentialing policies and procedures to ensure operational excellence.

Responsibilities

• Monitors, on an ongoing basis, all expirables, such as medical licenses, DEA certificates, Furnishing license, Fluoroscopy certificate, board certification and malpractice insurance, BLS, etc.

• Answers escalated departmental emails and main phone line calls.

• Develop and maintain a qualified medical staff by overseeing the credentialing process for all new providers and reappointments.

• Monitor the medical staff status to ensure compliance with federal and state regulations.

• Maintain a comprehensive database of medical staff information.

• Monitor all privileging credential documents to ensure accuracy.

• Facilitate communication between the medical staff and other departments.

• Consult with external organizations to ensure compliance with credentialing requirements.

• Ensure all stakeholders are informed of credential updates and changes.

• Participate in the development and implementation of quality improvement programs.

• Perform other duties as assigned.

Requirements

• Excellent written and verbal customer service skills.

• Ability to stay organized and perform effectively in a fast-paced, high-pressure environment.

• Strong judgment and decision-making skills.

• 5+ years of experience managing various insurance types, including HMO, FQHC, PPO, and IPA.

• Medicare PECOS and Medi-Cal PAVE Enrollment required.

• Experience with Durable Medical Equipment (DME) Revalidations, Reassignments, and Enrollment.

• Strong complex problem-solving skills.

• Ability to evaluate information and ensure compliance with standards.

• Experience coaching and developing others.

• Demonstrates integrity in all professional interactions.

• Adaptable and flexible to changing priorities and environments.

• High attention to detail.

• Proficient in Credential Stream, Cactus, Credential My Doc (CMD), Microsoft Excel, Outlook, Zoom, Teams, Word, Adobe PDF, and internet research.

• Works effectively both independently and as part of a team.

Education:

• Some college coursework preferred, but no degree required; or 5–10 years of relevant work experience.

Reports To: Senior Credentialing Manager

Work Schedule: On-Site, Monday-Friday, 8:30am-5:00pm.

Salary Range: $56,128-$70,174

Start date: ASAP