Lead – Credentialing

PatternEP - https:/healthreconconnect.com/sitemap.xml - om; India; Hybrid; INR 1,800,000 - 3,000,000; Full time

Job summary

HealthRecon Connect is seeking a Lead – Credentialing to oversee end-to-end credentialing operations for assigned client portfolios in a hybrid work model. The role emphasizes timely provider enrollment, quality standards, and team performance, while ensuring HIPAA, ISO, and organizational compliance.

As a leader, you will drive workforce planning, QA checks, training, and stakeholder management, with a strong emphasis on meeting credentialing targets, payer approvals, and client satisfaction in

Qualifications

• Bachelor's degree or higher required.
• Minimum 5 years of total professional experience.
• Minimum 5-6 years of RCM experience in Credentialing.
• At least 2 years of people management experience.
• Strong knowledge of Credentialing processes and RCM.

Responsibilities

• Manage credentialing workload and resource allocation to maximize productivity.
• Develop and present credentialing plans for assigned client portfolios.
• Monitor timely submission and follow-up of credentialing applications.
• Ensure credentialing turnaround times (TATs) are achieved.
• Drive daily credentialing targets and assigned payer approval rates.
• Resolve client-related issues within agreed service levels.

Skills

Credentialing processes

Revenue Cycle Management

Leadership

Stakeholder management

Education

Bachelor's Degree

Job description

HealthRecon Connect provides technology-enabled Revenue Cycle Management solutions to US healthcare providers. The company leverages over 30 years of deep domain expertise, machine learning, AI, cutting-edge analytics, and automated workflows that help improve cash flow, patient outcomes and enable peace of mind for their clients. At HealthRecon Connect, day after day, we not only hold ourselves accountable for setting and maintaining high standards, but we also passionately strive for the highest achievement, customer delight and thrive on the challenge of high expectations and commitment to excel.

HealthRecon was certified a Great Workplace by Great Place to Work® Sri Lanka since 2018 and was adjudged one of the 40 Best Workplaces in Sri Lanka by Great Place to Work® Sri Lanka in 2021. We are also a participant of the United Nations Global Compact.

We are looking for Lead – Credentialing to join our team.

The incumbent is responsible for overseeing end-to-end credentialing operations for assigned client portfolios, ensuring timely provider enrollment, maintaining quality standards, managing team performance, driving client satisfaction, and ensuring compliance with HIPAA, ISO, and organizational requirements. The role also includes workforce planning, reporting, quality assurance, training, and stakeholder management.

Due to the large volume of applications we receive, all applications will be reviewed in the order in which they were received and only the candidates short-listed for the first round of interviews will be contacted. Thank you for your understanding.

Job Vacancy

Lead – Credentialing

Work Week

Monday to Friday

Shift Window

7.30 PM – 4.30 PM IST

Important: HealthRecon Connect currently operates under a hybrid work arrangement, with the number of remote workdays varying by team. However, depending on client deliverables and business needs, employees may be required to work on-site for all five weekdays.

By applying, you acknowledge and agree to be available for in-person work five days a weekifrequired.

Other Features

US calendar applicable

Responsibilities

Operational Management

• Manage credentialing workload and resource allocation to maximize productivity.
• Develop and present credentialing plans for assigned client portfolios.
• Monitor timely submission and follow-up of credentialing applications.
• Ensure credentialing turnaround times (TATs) are achieved.
• Drive daily credentialing targets and assigned payer approval rates.
• Resolve client-related issues within agreed service levels.

Quality & Compliance

• Conduct root cause analysis (RCA) for rejected credentialing applications.
• Maintain compliance with HIPAA, ISO, and company regulatory standards.
• Perform periodic quality audits and random QA checks.
• Ensure 98% communication accuracy with insurance companies.
• Monitor adherence to SOPs and ensure timely updates.

Team Leadership & Workforce Management

• Support workforce planning, utilization, and capacity management.
• Monitor team productivity, quality, and performance metrics.
• Conduct employee evaluations and provide coaching and feedback.
• Deliver On-the-Job Training (OJT) and facilitate onboarding of new hires.
• Foster adherence to company values and professional standards.

Client & Stakeholder Management

• Liaise with clients and internal leadership on credentialing performance.
• Ensure timely responses to internal and external communications.
• Present operational updates, reports, and improvement initiatives.
• Maintain accountability for assigned client accounts.

Reporting & Performance Monitoring

• Share daily and weekly operational reports within established timelines.
• Track credentialing approval rates, TAT, productivity, and quality metrics.
• Provide performance insights and recommendations to leadership.

Key Performance Indicators (KPIs)

• Credentialing Turnaround Time (TAT).
• Daily credentialing productivity targets.
• Assigned payer approval rate after 30 days.
• Application approval rate.
• Client SLA/TAT adherence.
• 98% communication accuracy.
• Quality audit scores and compliance adherence.

Qualifications/Criteria

• Bachelor’s Degree in any discipline.
• Strong knowledge of Credentialing processes and Revenue Cycle Management (RCM).
• Excellent written and verbal communication skills.
• Strong interpersonal, leadership, and stakeholder management skills.
• Ability to work under pressure and meet strict deadlines.
• Minimum 5 years of total professional experience.
• Minimum 5-6 years of RCM experience in Credentialing department.
• At least 2 years of people management experience.
• Proven experience leading credentialing teams and managing client portfolios.