Credentialing Team Lead

Job Description

Time: 6:00 pm to 3:00 am Location : Pune Balewadi Highstreet Key Responsibilities Supervise and mentor a team of credentialing specialists to ensure all credentialing and re-credentialing processes are completed accurately and on time. Maintain and monitor credentialing timelines and compliance with payer, hospital, and licensing requirements. Oversee the preparation and submission of initial and renewal credentialing applications for providers across Medicare, Medicaid, and commercial payers. Ensure timely updates and accuracy of provider data in CAQH, PECOS, NPPES, and other credentialing databases. Manage provider licensing renewals (e.g., state licenses, DEA, CDS) and revalidation processes. Collaborate closely with the Revenue Cycle and Billing teams to proactively address claim denials or authorization issues related to credentialing. Conduct regular audits of provider files and credentialing records to ensure full regulatory and payer compliance. Maintain and regularly update internal credentialing dashboards and provider grids for reporting. Act as a liaison with payers and healthcare institutions to resolve escalations or delays. Drive process improvements and implement best practices in credentialing workflows. Prepare credentialing reports for leadership and support in internal and external audits. Perform other duties as assigned by leadership. Serve as company liaison with 3rd party payers; Manage update to date information regarding fee schedules; Grow and manage a team of credentialing coordinators; Manage and update credentialing & clinic licensure policies and protocols; Ensure reports on credentialing status of providers is up to date and accurate; Define and implement processes to ensure credentialing is completed and up to date in a timely manner; Manage process of negotiating new insurance contracts; Ensure all clinic information is accurate within 3rd party payer directory; Drive and implement seamless protocols for gathering credentialing data from health care providers Show more Show less