Team Lead

2 weeks ago

Noida, Uttar Pradesh, India R Systems Full time

Job Title: Team Leader – Credentialing

Department: US Healthcare Operations

Location: Noida

Experience Required: 6–10 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

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