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About the Role
The Sr. Credentialing Lead is accountable for the end-to-end performance, output, and compliance of the credentialing department. This role drives KPI attainment, enforces operational discipline, manages team productivity, and ensures all credentialing pipelines move efficiently from intake through approval. This is a results-driven leadership role measured by turnaround times, accuracy, client satisfaction, and adherence to regulatory and internal standards.
Responsibilities
- Own and drive all credentialing workflows across clients and payers.
- Oversee full lifecycle from intake through approval.
- Enforce standardized workflows across all specialists.
- Identify bottlenecks and implement process improvements.
- Ensure payer-specific requirements are met on first submission.
- Oversee completion of all EFT, ERA, and EDI enrollments.
- Track enrollment status from submission through approval.
- Ensure alignment with billing systems and clearinghouse requirements.
- Troubleshoot enrollment issues and payer discrepancies.
- Maintain accurate records of confirmations and effective dates.
- Partner with billing and revenue cycle teams to prevent delays.
- Implement tracking systems to eliminate revenue impact from enrollment gaps.
- Manage team output and accountability.
- Conduct monthly audits across team members and clients.
- Assign and rebalance workloads based on priorities.
- Enforce accountability through corrective action plans.
- Lead daily and weekly production meetings.
- Train, mentor, and develop team members.
- Ensure consistent service delivery across all accounts.
- Lead or oversee client communications.
- Provide weekly status reports with actionable insights.
- Manage escalations and resolve issues proactively.
- Align credentialing timelines with client expectations.
- Maintain accurate documentation in Monday.com.
- Maintain strict internal and external communication standards.
- Ensure real-time documentation of all updates and actions.
- Collaborate with billing, coding, and onboarding teams.
- Enforce structured communication protocols across the department.
Requirements
- Minimum 4+ years in credentialing operations.
- 3+ years in a leadership or management role.
- Experience managing multi-client credentialing portfolios.
- Strong knowledge of CAQH, NPPES, PECOS, and payer enrollment processes.
- Understanding of multi-state credentialing requirements.
- Strong attention to detail and organizational skills.
- Excellent communication and interpersonal skills.
Skills
- Operations Knowledge
- Strategic Execution
- Compliance Knowledge
- Organization
- Teamwork
- Computer Skills
Experience Level
- 4+ years in credentialing operations
- 3+ years in leadership or management role
Education Level
- Associates Degree required
- Bachelor’s Degree in Healthcare Administration, Business Administration, or related field preferred
- CPCS certification preferred