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.
