Credentialing Team Lead

Description

Credentialing Team leads, oversee and manage the entire credentialing process for healthcare

providers, ensuring compliance with regulations and accreditation standards, while also leading and

supporting the credentialing team. Developing and maintaining policies and procedures and ensuring

accurate and timely completion of credentialing activities.

Responsibilities

• Monitors, on an ongoing basis, all expirables, such as medical licenses, DEA certificates,

Furnishing license, Fluoroscopy certificate, board certification and malpractice insurance,

Bls, Etc.

• Answers escalated departmental emails and main phone line calls.
• Develop and maintain a qualified medical staff by overseeing the credentialing process for

all new providers and reappointments.

• Monitor the medical staff status to ensure compliance with federal and state regulations.
• Maintain a comprehensive database of medical staff information.
• Monitor all privileging credential documents to ensure accuracy.
• Facilitate communication between the medical staff and other departments.
• Consult with external organizations to ensure compliance with credentialing requirements.
• Ensure all stakeholders are informed of credential updates and changes.
• Participate in the development and implementation of quality improvement programs.
• Perform other duties as assigned.

Requirements

• Excellent customer service written and verbal skills.
• Judgement and decision making
• 5+ years in managing various insurance types: HMO, FQHC, PPO and IPA.
• Medicare PECOS/Medi-Cal PAVE Enrollment
• Durable Medical Equipment (DME) Revalidations/Reassignments/Enrollment
• Complex problem solving
• Evaluating information to determine compliance with standards
• Coaching and developing others.

• Integrity

• Adaptability/Flexibility

• High attention to detail.
• Proficient Technical skills Credential Stream, Cactus, Credential My Doc (CMD) (including

Microsoft Excel, Outlook, Zoom, Teams, Word, Adobe PDF, & Internet)

• Works well as a team and independently.
• Positive “can do” attitude.

Education:

Some college no degree required or 5- 10 years of work experience.

Reports To: Senior Credentialing Manager

• Work Schedule: Monday-Friday 8:30am-5:00pm.
• Salary Range: $56,128-$70,174
• Start date: ASAP