Team Lead , Credentialing

People Management & Team Leadership

Lead and manage a team of Credentialing Specialists and Operational Analysts to ensure timely and accurate credentialing file processing.

Provide coaching, mentoring, and training to team members to strengthen credentialing knowledge and regulatory understanding.

Oversee credentialing workflows to ensure compliance with NCQA guidelines, state regulatory requirements, and client-specific policies.

Facilitate company performance reviews, and partner with Operations Management to determine performance ratings for the OAs on your team and deliver performance review conversations directly to your team members.

You will host a daily standup with your team as needed to review the previous day’s performance and align on priorities for the day ahead. Additionally, you will lead a weekly performance review to recap results from the prior week and identify opportunities for improvement.

Support the onboarding of new hires, provide education and guidance to team members during training, and eventually participate in the hiring process for new OAs joining your team.

Regularly review your team’s performance data on a daily and weekly basis, and communicate insights upward to management, downward to your team, and laterally to your peers to ensure alignment and accountability across all levels.

Production Management

This role is responsible for meeting core performance metrics for the subset of clients supported by your pod.

These metrics focus on the speed, quality, and efficiency of file processing.

You will be expected to continuously identify and drive improvements in each of these areas as volumes scale.

Monitor the contractual Service Level Agreement, turnaround times, and quality metrics; drive corrective actions to maintain compliance and efficiency.

Partner with internal stakeholders to resolve escalations, streamline workflows, and improve operational outcomes.

Maintain proactive communication with OAs to ensure they remain unblocked and productive.

Identify process gaps and implement documented improvements.

Facilitate team training sessions as needed to strengthen skills and ensure process consistency.

What You'll Need

• Credentialing experience is a must have.
• Minimum of 5+ years of overall professional experience, with at least 2 years in a team management role.
• Proven experience working effectively with cross-functional teams.
• Strong exposure to collaborating with global teams and stakeholders.
• Demonstrated success in client engagement and managing client relationships.
• A passion for driving continuous improvement in metrics week over week, coupled with a desire to dive deep into processes to understand how they function and how they connect to key company outcomes.
• Ability to be hands-on and execution-focused in the short term while also thinking strategically to drive long-term success.
• Serve as the primary point of contact for client engagement, including participating in client meetings, addressing escalations, and ensuring client satisfaction.
• Proven excellence in organization and attention to detail.
• Proven ability to manage multiple initiatives simultaneously with a clear track record of prioritizing the most critical objectives.
• Strong organizational, analytical, and problem-solving skills.
• Excellent written and verbal communication skills.
• Proven ability to effectively manage in a production environment while overseeing and driving daily performance metrics.

Nice To Have

• Minimum 2-3 years of experience in credentialing, provider enrollment, or healthcare setting and compliance.
• Strong knowledge of NCQA guidelines and state/federal regulatory requirements related to credentialing.
• Proficient in SQL, Excel Macros, and related data analysis tools.