Credentialing Team Lead

BASS Medical Group; Walnut Creek, Northern (CA, KY); On-site; USD 90,000 - 120,000; Full time

Job summary

Paylocity seeks a Credentialing Team Lead to oversee the credentialing process for healthcare providers, ensuring compliance with regulations and accreditation standards. This role leads, supports, and develops the credentialing team while maintaining accurate and timely credentialing activities.

The position also develops and maintains credentialing policies and procedures to ensure operational excellence and coordinates with internal and external stakeholders to uphold high-quality

Qualifications

• 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.

Responsibilities

• Oversees and manages the credentialing process for healthcare providers.
• Maintains accurate and timely credentialing activities and develops policies.
• Ensures compliance with federal and state regulations and accreditation standards.
• Leads the credentialing team, supports training and development.
• Maintains a comprehensive database of medical staff information.
• Monitors expirable credentials and documentation.
• Facilitates communication between medical staff and other departments.
• Collaborates with external organizations to ensure credentialing requirements are met.
• Keeps stakeholders informed of credentialing updates and changes.
• Contributes to quality improvement programs.

Skills

Communication skills

Organization

Decision-making

Problem-solving

Mentoring

Integrity

Adaptability

Attention to detail

Teamwork

Independent work

Education

Some college coursework preferred

Tools

CredentialStream

Cactus

CredentialMyDoc (CMD)

Microsoft 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