Team Lead - Credentialing | U.S Healthcare
- R Systems
- 7 - 12 years
- Noida, Gurugram
- 6 months ago
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Job Description
Job Title: Team Leader Credentialing
Department: US Healthcare Operations
Location: Noida
Experience Required: 610 Years
Employment Type: Full-Time
Job Summary:
We are seeking a dynamic and experienced Team Leader Credentialing to oversee and manage a credentialing team within the US healthcare domain. The ideal candidate will be responsible for ensuring timely and accurate provider enrollment, re-credentialing, and compliance with payer and regulatory standards. This role demands strong leadership, process optimization, and stakeholder management skills to maintain high levels of quality and client satisfaction.
Responsibilities:
- Lead and supervise daily operations of the credentialing team, ensuring adherence to client, payer, and regulatory guidelines.
- Manage end-to-end provider enrollment and re-credentialing processes with insurance networks, hospitals, and healthcare facilities.
- Review provider documentation for accuracy, completeness, and compliance prior to submission.
- Monitor turnaround times and ensure timely completion of credentialing tasks.
- Serve as the primary escalation point for complex credentialing issues, collaborating with payers and providers for resolution.
- Train, mentor, and evaluate team members to uphold quality standards and meet productivity goals.
- Generate and analyze reports on credentialing status, performance metrics, and compliance indicators.
- Coordinate with internal departments, clients, and third-party entities to streamline credentialing workflows.
- Stay updated on payer policies, NCQA standards, and healthcare compliance regulations.
- Identify and implement process improvements to enhance operational efficiency and client satisfaction.
Mandatory Skills:
- Strong expertise in Credentialing, Provider Enrollment, and US Healthcare Regulations
- Proven leadership and team management capabilities
- Excellent communication and problem-solving skills
- Proficiency in credentialing software and reporting tools
Job Classification
Industry: BPM / BPOFunctional Area / Department: Customer Success, Service & OperationsRole Category: OperationsRole: Team LeaderEmployement Type: Full timeContact Details:
Company: R SystemsLocation(s): Noida, Gurugram
Keyskills: Credentialing NCQA Enrollment US Healthcare Management RCM
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