Credentialing Team Lead

Role Description

The Team Lead is responsible for overseeing the day-to-day operations of the credentialing team, ensuring accuracy, compliance, and efficiency across all credentialing activities. This role focuses on quality oversight, workflow coordination, and team support rather than direct credentialing production.

• Provide day-to-day oversight of Credentialing Specialists, ensuring work is completed accurately, timely, and in alignment with established processes.
• Monitor team performance, workload distribution, and turnaround times, identifying and addressing gaps or delays in real time.
• Conduct routine quality reviews and audits of credentialing files to ensure compliance with internal policies and regulatory standards (e.g., CMS, Joint Commission).
• Analyze credentialing data and reports to ensure accuracy, completeness, and data integrity, identifying trends, risks, and areas for improvement.
• Serve as a primary escalation point for complex credentialing issues, providing guidance and resolution support to team members.
• Oversee and coordinate daily workflow operations, ensuring efficient processing of initial applications, reappointments, and expirables.
• Support audit readiness efforts, including preparation for internal and external reviews.
• Assist with training, onboarding, and ongoing coaching of Credentialing Specialists to promote consistency and adherence to standards.
• Collaborate with leadership to provide performance insights, reporting, and recommendations to improve team efficiency and quality.
• Partner with cross-functional teams to resolve credentialing barriers and support operational initiatives and process improvements.
• Monitor compliance with HIPAA, data security, and confidentiality requirements.
• Support onboarding of new facilities, including system setup, workflow alignment, and documentation requirements.
• Oversee and support completion of credentialing-related system tickets and requests (e.g., ServiceNow).

Qualifications

• High school diploma or equivalent, or combination of education and experience required for the job.
• Minimum 3+ years of credentialing experience within a healthcare system environment.
• Strong knowledge of medical staff credentialing processes, including provider enrollment, privileging, and reappointment cycles.
• Working knowledge of regulatory and accreditation standards (e.g., CMS, Joint Commission, NCQA).
• Demonstrated ability to review credentialing files for accuracy, completeness, and compliance.
• Experience working with medical staff leadership, providers, and internal stakeholders.
• Strong attention to detail with the ability to identify discrepancies, trends, and risks.
• Ability to manage multiple priorities in a fast-paced, high-volume environment.
• Effective communication skills with the ability to support, guide, and influence team members.

Requirements

• Experience in a Centralized Verification Organization (CVO) or shared services credentialing environment.
• Prior experience in a lead, mentor, or SME capacity within a credentialing team.
• Experience supporting audit readiness and quality assurance processes.
• Proficiency with credentialing systems (e.g., CredentialStream, Cactus, MD-Staff, or similar).
• Intermediate Microsoft Excel and reporting skills.

Benefits

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.