Credentialing Team Lead

Job Description

Job Description

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.

Key Responsibilities

• Monitors, on an ongoing basis, all expirable credentials and documents, including medical licenses, DEA certificates, furnishing licenses, fluoroscopy certificates, board certifications, malpractice insurance, BLS certifications, and other required credentials. 
• Answers escalated departmental emails and incoming calls to the main phone line. 
• Develops and maintains a qualified medical staff by overseeing the credentialing process for all new providers and reappointments. 
• Monitors medical staff status to ensure compliance with federal and state regulations. 
• Maintains a comprehensive and accurate database of medical staff information. 
• Monitors all privileging and credentialing documents to ensure accuracy and completeness. 
• Facilitates communication between medical staff and other departments. 
• Consults with external organizations to ensure compliance with credentialing requirements. 
• Ensures all appropriate stakeholders are informed of credentialing updates and changes. 
• Participates in the development and implementation of quality improvement programs. 
• Performs other duties as assigned.

Requirements:

  Qualifications, Skills & Experience 

• Excellent written and verbal communication and customer service skills. 
• Ability to stay organized and perform effectively in a fast-paced, high-pressure environment. 
• Strong judgment and decision-making skills. 
• Five (5) or more years of experience managing various insurance types, including HMO, FQHC, PPO, and IPA. 
• Medicare PECOS and Medi-Cal PAVE enrollment experience required. 
• Experience with Durable Medical Equipment (DME) revalidations, reassignments, and enrollment. 
• Strong complex problem-solving skills. 
• Ability to evaluate information and ensure compliance with applicable standards. 
• Experience coaching, mentoring, and developing others. 
• Demonstrates integrity and professionalism in all interactions. 
• Adaptable and flexible in response to changing priorities and work environments. 
• Strong attention to detail and accuracy. 
• Proficient in CredentialStream, Cactus, CredentialMyDoc (CMD), Microsoft Excel, Outlook, Zoom, Microsoft Teams, Word, Adobe PDF, and internet research. 
• Ability to work effectively both independently and as part of a team. 
• Some college coursework preferred, but a degree is not required; alternatively, five (5) to ten (10) years of relevant work experience. 

Reports To: Senior Credentialing Manager