Credentialing Team Lead

Company: Credifide

Location: Mohali

Shift: US Timings

Working Days: Monday to Friday (On-site)

Job Type: Full-time

Role Summary

The Credentialing Team Lead is responsible for overseeing the end-to-end provider enrollment and primary source verification processes. This role balances direct handling of complex provider files with the supervision of a team of specialists to ensure all insurance panels and hospital privileges are secured accurately and on schedule.

Key Responsibilities

• Team Supervision: Manage the daily workflow of Credentialing Specialists, assigning provider files and monitoring progress to ensure no applications stall.
• Application Management: Oversee the submission and follow-up of initial credentialing and re-credentialing applications for various specialties (Medicare, Medicaid, and Commercial payers).
• Quality Control: Review completed applications for accuracy and compliance before submission to minimize delays or denials.
• Training & Development: Lead the onboarding of new hires and provide ongoing training to the team on updated payer requirements, portal navigation, and internal SOPs.
• Payer Relations: Act as the primary point of contact for insurance payers to resolve enrollment discrepancies, contract issues, or "pended" applications.
• Reporting: Maintain and update a centralized tracking database. Provide weekly status reports to management regarding provider "billable" status.
• Compliance: Ensure all provider data is current in CAQH, NPPES, and PECOS. Monitor expiration dates for licenses, DEAs, and board certifications.
• Problem Solving: Serve as the escalation point for the team when facing credentialing roadblocks or complex multi-state enrollment requirements.

Required Skills & Experience

• Experience: 6+ years of experience in medical credentialing and provider enrollment; 3+ year in a leadership or senior role.
• Knowledge: Deep understanding of NCQA standards, CMS guidelines, and the nuances of various state-specific payer requirements.
• Technical Proficiency: Hands-on experience with CAQH ProView, PECOS, and NPPES (NPI) portals. Strong skills in Excel for data tracking.
• Communication: Clear, professional communication skills for interacting with providers, office managers, and insurance representatives.
• Detail-Oriented: Ability to catch small errors in provider documentation that could lead to claim denials.