Senior Team Leader Provider Credentialing and Enrolment

Position Summary

We are looking for an experienced Senior Team Leader Provider Credentialing & Enrollment to lead a team handling end-to-end US healthcare provider credentialing and payer enrollment activities. The role will be responsible for team performance, quality, SLA/TAT, escalations, provider enrollment, recredentialing, payer follow-ups, and stakeholder management.

Key Responsibilities

• Lead, mentor and manage a team of Provider Credentialing / Enrollment Specialists and ensure achievement of productivity, quality and SLA targets.
• Oversee end-to-end provider credentialing, recredentialing, enrollment, revalidation, demographic updates and terminations.
• Manage credentialing and enrollment activities for individual providers, group practices and multiple specialties.
• Ensure accurate and timely processing through CAQH, PECOS, NPPES/NPI, Medicaid and commercial payer portals.
• Handle Medicare, Medicaid, Commercial, HMO/IPA and Managed Care payer enrollment activities.
• Review applications and provider documentation for completeness, accuracy and payer-specific requirements.
• Monitor application aging, pending cases, rejections, follow-ups, expirables and enrollment effective dates.
• Act as the first-level escalation point for complex credentialing and payer enrollment issues.
• Coordinate with US-based providers, clients, payer representatives and internal stakeholders to resolve issues and meet deadlines.
• Conduct quality audits, identify process gaps and implement corrective actions to improve accuracy and TAT.
• Prepare and publish MIS/KPI reports covering productivity, quality, aging, TAT and SLA performance.
• Train and coach team members on payer requirements, credentialing processes, portals and SOP updates.
• Identify opportunities for process improvement, standardization and automation.

Required Skills & Experience

• 6–10 years of experience in US Healthcare Provider Credentialing / Provider Enrollment.
• Minimum 2–3 years of experience in Team Lead / Senior Team Lead / supervisory role.
• Strong provider-side experience; candidates with only payer-side credentialing experience are not preferred.
• Hands-on experience with CAQH ProView, PECOS, NPPES/NPI, Medicare, Medicaid and Commercial payer portals.
• Strong understanding of provider documentation, licenses, DEA, board certification, malpractice insurance, taxonomy and revalidation.
• Experience managing team KPIs, SLA, productivity, quality and TAT.
• Strong escalation handling, problem-solving and stakeholder management skills.
• Excellent verbal and written communication skills with the ability to interact with US-based clients/providers.
• Experience in a Healthcare BPO / RCM / shared-services environment will be preferred.
• Good knowledge of MS Excel, reporting and credentialing trackers.

Education

Bachelor’s Degree Business Administration or any relevant discipline preferred.