Senior Credentialing Lead

Job Description

Job Description

Job Title:   Sr. Credentialing Lead

Reports to:   National Billing Manager

Supervises:   Credentialing Team

Position Summary:

The Sr. Credentialing Lead is accountable for the end to end performance, output, and compliance of the credentialing department. This role drives KPI attainment, enforces operational discipline, manages team productivity, and ensures all credentialing pipelines move efficiently from intake through approval.

This is a results driven leadership role measured by turnaround times, accuracy, client satisfaction, and adherence to regulatory and internal standards.

Key Performance Areas & Key Performance Indicators:

Credentialing Operations Management: (30%) 

• Own and drive all credentialing workflows across clients and payers
• Oversee full lifecycle from intake through approval
• Enforce standardized workflows across all specialists
• Identify bottlenecks and implement process improvements
• Ensure payer specific requirements are met on first submission  

Data Integrity, Compliance & Credentialing Systems: (10%) 

• Oversee completion of all EFT, ERA, and EDI enrollments
• Track enrollment status from submission through approval
• Ensure alignment with billing systems and clearinghouse requirements
• Troubleshoot enrollment issues and payer discrepancies
• Maintain accurate records of confirmations and effective dates
• Partner with billing and revenue cycle teams to prevent delays
• Implement tracking systems to eliminate revenue impact from enrollment gaps

Team Performance & Productivity Management: (25%) 

• Manage team output and accountability
• Conduct monthly audits across team members and clients
• Assign and rebalance workloads based on priorities
• Enforce accountability through corrective action plans
• Lead daily and weekly production meetings
• Train, mentor, and develop team members

 

Client Delivery & Satisfaction: (20%) 

• Ensure consistent service delivery across all accounts
• Lead or oversee client communications
• Provide weekly status reports with actionable insights
• Manage escalations and resolve issues proactively
• Align credentialing timelines with client expectations
• Maintain accurate documentation in Monday.com

Communication & SLA Enforcement: (15%) 

• Maintain strict internal and external communication standards
• Ensure real time documentation of all updates and actions
• Collaborate with billing, coding, and onboarding teams
• Enforce structured communication protocols across the department

Minimum Qualifications

Education:

• Associates Degree required
• Bachelor’s Degree in Healthcare Administration, Business Administration, or related field preferred
• CPCS certification preferred

Experience:

• Minimum 4+ years in credentialing operations
• 3+ years in leadership or management role
• Experience managing multi client credentialing portfolios
• Strong knowledge of CAQH, NPPES, PECOS, and payer enrollment processes
• Understanding of multi state credentialing requirements
• Strong attention to detail and organizational skills
• Excellent communication and interpersonal skills

Competencies

Operations Knowledge –  Thoroughly understands the operational procedures for his/her position and how they affect or relate to other departments in the company. Serves as an expert for others.

Strategic Execution –  Capable of translating concepts into detailed plans and managing timelines with discipline and focus.

Compliance Knowledge – Extensive understanding of general and department-specific regulations. Serves as a compliance resource for the team.

Organization –  Maintains control of multiple priorities, builds systems that eliminate scheduling conflicts, and supports seamless daily flow.

Teamwork – Able to build morale and group commitments to goals and objectives; Balances team and individual responsibilities; Exhibits objectivity and openness to others’ views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Supports everyone’s efforts to succeed.

Computer Skills – Demonstrates a solid understanding of the technology utilized in his/her position. Consistently looks for ways to use technology to create efficiencies. Able to troubleshoot minor problems. May serve as an expert to others.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Strength -  Employee must be able to stand and/ or sit for periods of time while waiting on customers. Employee may be required to walk, reach, lift, carry and bend. This job also requires the ability to lift and/or move up to 15 lbs. Occasionally, may need to lift more than 15 lbs.

Finger Dexterity -  Employee will have to use fingers to make small movements, such as typing, picking up small objects, or pinching fingers together.

Talking – The ability to convey information accurately by speaking to customers and other employees. 

Hearing -  Able to hear average or normal conversations and receive ordinary information.

Visual Abilities – Specific vision abilities used by the job are close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

  Employer reserves the right to change this job description at any time, should business needs arise.