Credentialing Lead -Healthcare (In Person)

Credentialing Lead

The Credentialing Lead is responsible for Credentialing Committee Preparation, overseeing the complete lifecycle of provider credentialing, including file review, verification, committee preparation, and ongoing monitoring. This role ensures compliance with NCQA, TJC, CMS, State regulations, organizational policies, and delegated credentialing requirements.

• Credentialing Committee & Compliance Oversight
• Oversee preparation of credentialing packets for all meetings, ensuring accuracy, completeness, and regulatory alignment.
• Present all files, terminations, meeting minutes, and new business items to the Credentialing Committee, ensuring materials are complete and compliant.
• Manage agendas, meeting schedules, follow-ups, minutes, and voting documentation.
• Collaborate with Medical Directors to finalize meeting materials, especially for redflagged providers.
• Oversee all delegated credentialing compliance requirements, including coordination of annual audits and preparation of semiannual delegation reports, ensuring accuracy, timely submission, and adherence to regulatory and contractual standards.
• Serve as a key liaison to Operations, People and Culture, and Malpractice Departments, ensuring seamless information-sharing, timely updates, onboarding coordination, and collaboration on provider readiness and risk-related matters.
• Supervision & Operational Oversight
• Supervise and mentor Credentialing staff; monitor workload and performance standards.
• Provide training on credentialing requirements, verification processes, and committee procedures.
• Conduct file audits to ensure accuracy and quality.
• Cook up coordination with onboarding staff, internal departments, and compliance teams to support provider readiness.
• Prepare verification related payment requests.
• Utilize credentialing databases to track status, outcomes, and followup tasks; prepare reports and dashboards for leadership.

Qualifications

• 3-5 years of healthcare credentialing or medical staff services experience.
• Bachelor's or 7 years of relevant working experience required.
• 1-2 years of supervisory or team lead experience.
• Strong knowledge of NCQA, TJC, CMS, and State regulatory standards.
• Excellent attention to detail, organization, and ability to manage multiple priorities.
• Strong communication skills and ability to work with executive and clinical leadership.

Preferred

• Certified Notary - New York State
• CPCS or CPMSM certification (or willingness to obtain).
• Experience with credentialing systems (MD Staff, Medallion, Passport, MD Staff, Modio, etc.).