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Credentialing Team Lead (12 Dec 25)

5 years

0 Lacs

hyderābād

Posted:5 days ago| Platform: GlassDoor logo

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Skills Required

credentialing verification certifications data management enrollment compliance maintenance regulations audits resolve healthcare communication

Work Mode

On-site

Job Type

Part Time

Job Description

Job Description:
Job Role: Credentialing Team lead
Location: Hyderabad

Key responsibilities
  • Application and verification: Complete and submit credentialing applications, verify provider credentials (licenses, board certifications, etc.) through primary source verification, and ensure all required information is accurate and complete.
  • Payer and data management: Maintain provider data with insurance companies, update profiles in systems like CAQH, and manage enrollment with various payers (commercial, Medicare, Medicaid).
  • Compliance and maintenance: Monitor credentialing timelines for re-credentialing and expirations, ensure ongoing compliance with state and federal regulations, and conduct audits to identify and mitigate risks.
  • Problem resolution: Follow up with payers on application status, resolve missing information or exceptions, and address credentialing-related claim denials.
  • Administrative duties: Maintain organized and confidential files, respond to inquiries, and assist with special projects as needed.
Essential skills and qualifications
  • Experience: 5+Years Previous experience in provider credentialing, RCM, or a related healthcare role is essential.
  • Knowledge: Familiarity with relevant systems and databases (e.g., CAQH, NPPES, PECOS) and payer-specific requirements is crucial.
  • Skills: Strong attention to detail, excellent organizational and communication skills, ability to work independently and meet deadlines, and proficiency with computer systems are required.
  • Education: A bachelor's degree in Healthcare Administration or a related field is often required.

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