Team Lead, Credentialing

Overview

Responsibilities

• Supervise and manage the Credentialing team, including hiring, training, performance evaluations, and scheduling.
• You’ll be the direct manager for a team that is responsible for hitting daily and weekly targets, constantly driving towards improved performance of our file processing even as volume grows.
• Responsible for the growth paths and success of your direct reports which includes Operations Associates (OAs), focusing on both individual and team metrics.
• Hold weekly 1:1 meetings with the Operations Associates on the Credentialing team to review file quality and throughput, any blockers, ideas for improvement, and professional development. Lean in with lower and middle performers to coach them on improving their file quality and production.
• During company performance reviews, coordinate with leadership to determine performance ratings for the OAs on your team and deliver performance review conversations for your team members.
• Host daily standups with your team to cover previous day’s performance and the plan for current day. Additionally, conduct a review on performance from the last week with the team.
• Ensure timely and accurate credentialing and re-credentialing of healthcare providers.
• Maintain and update the credentialing database and provider files.
• Monitor compliance with regulatory requirements and accreditation standards (e.g., NCQA, Joint Commission).
• Develop and implement credentialing policies and procedures.
• Serve as a resource and point of contact for credentialing-related inquiries.
• Prepare reports and present credentialing metrics to leadership.
• Collaborate with other departments, such as Human Resources and Compliance, on credentialing matters.
• Stay current on industry trends and changes in credentialing regulations.
• Work to help onboard new hires; educating and supporting new team members as they train, and eventually you will be involved in the hiring process for new OAs who join your team.
  

Qualifications And Competencies

• Any graduate or post-graduate degree
• Minimum 3 years of experience in U.S Healthcare system, provider and facility Credentialing.
• At least 2 years of experience in a supervisory or leadership role.
• Knowledge of CAQH
• Familiarity with NCQA, Joint Commission, and other regulatory requirements
• Strong organizational, communication, and problem-solving skills
• Knowledge of Microsoft Office and Google applications (Google Doc, Spreadsheets, Forms, Calendar)
• A strong track record of juggling multiple initiatives and clear ability to prioritize
  

Reporting Structure

• Reports to: Credentialing Manager/Associate Director
• Direct Reports: Operations Associates