Credentialing Team Lead

Bass Privia Management Company of California, LLC; Walnut Creek (CA); On-site; USD 120,000 - 160,000; Full time

Job summary

Bass Privia Management Company of California, LLC seeks a Credentialing Team Lead to oversee the credentialing process for healthcare providers and ensure regulatory compliance. You will lead, support, and develop the credentialing team while maintaining accurate and timely credentialing activities.

Responsibilities include monitoring expirable credentials, maintaining staff databases, and ensuring coordination with other departments.

Qualifications

• Excellent written and verbal communication and customer service.
• Ability to stay organized and perform effectively in a fast-paced environment.
• Strong judgment and decision-making skills.
• Five+ years of experience managing various insurance types (HMO, FQHC, PPO, IPA).
• Medicare PECOS and Medi-Cal PAVE enrollment experience required.
• Experience with DME revalidations, reassignments, and enrollment.
• Strong complex problem-solving skills.
• Experience coaching, mentoring, and developing others.

Responsibilities

• Monitors expirable credentials and documents for all providers.
• Answers escalated departmental emails and incoming calls.
• Develops and maintains credentialing for new providers and reappointments.
• Monitors compliance with federal and state regulations among medical staff.
• Maintains a comprehensive database of medical staff information.
• Oversees privileging and credentialing documents for accuracy.
• Facilitates communication between medical staff and other departments.
• Consults with external organizations to ensure regulatory compliance.
• Supports quality improvement programs and initiatives.
• Performs other duties as assigned.

Skills

Communication skills

Customer service

Organization

Decision making

Insurance enrollment experience

Mentoring

Quality improvement

Education

Some college coursework preferred

Tools

CredentialStream

Cactus

CredentialMyDoc

Excel

Outlook

Zoom

Microsoft Teams

Word

Adobe PDF

Internet research

Job description

Description

The Credentialing Team Lead oversees and manages the entire credentialing process for healthcare providers, ensuring compliance with all regulations and accreditation standards. This role leads, supports, and develops the credentialing team, while maintaining accurate and timely completion of all credentialing activities. The Team Lead also develops and maintains credentialing policies and procedures to ensure operational excellence.

Key Responsibilities

• Monitors, on an ongoing basis, all expirable credentials and documents, including medical licenses, DEA certificates, furnishing licenses, fluoroscopy certificates, board certifications, malpractice insurance, BLS certifications, and other required credentials.
• Answers escalated departmental emails and incoming calls to the main phone line.
• Develops and maintains a qualified medical staff by overseeing the credentialing process for all new providers and reappointments.
• Monitors medical staff status to ensure compliance with federal and state regulations.
• Maintains a comprehensive and accurate database of medical staff information.
• Monitors all privileging and credentialing documents to ensure accuracy and completeness.
• Facilitates communication between medical staff and other departments.
• Consults with external organizations to ensure compliance with credentialing requirements.
• Ensures all appropriate stakeholders are informed of credentialing updates and changes.
• Participates in the development and implementation of quality improvement programs.
• Performs other duties as assigned.

Requirements

Qualifications, Skills & Experience

• Excellent written and verbal communication and customer service skills.
• Ability to stay organized and perform effectively in a fast-paced, high-pressure environment.
• Strong judgment and decision-making skills.
• Five (5) or more years of experience managing various insurance types, including HMO, FQHC, PPO, and IPA.
• Medicare PECOS and Medi-Cal PAVE enrollment experience required.
• Experience with Durable Medical Equipment (DME) revalidations, reassignments, and enrollment.
• Strong complex problem-solving skills.
• Ability to evaluate information and ensure compliance with applicable standards.
• Experience coaching, mentoring, and developing others.
• Demonstrates integrity and professionalism in all interactions.
• Adaptable and flexible in response to changing priorities and work environments.
• Strong attention to detail and accuracy.
• Proficient in CredentialStream, Cactus, CredentialMyDoc (CMD), Microsoft Excel, Outlook, Zoom, Microsoft Teams, Word, Adobe PDF, and internet research.
• Ability to work effectively both independently and as part of a team.
• Some college coursework preferred, but a degree is not required; alternatively, five (5) to ten (10) years of relevant work experience.

Reports To: Senior Credentialing Manager