Credentialing Team Lead

The Credentialing Team Lead oversees the daily operations of the credentialing team to ensure accurate, efficient, and compliant processing of provider applications, verifications, and re-credentialing activities. This role serves as the primary liaison between the credentialing team, leadership, and other departments to maintain compliance with regulatory and payer requirements. The Team Lead is responsible for workflow coordination, staff training, quality assurance, and continuous process improvement within the credentialing function.

Key Responsibilities:

Leadership & Team Oversight

· Supervise day-to-day credentialing activities to ensure timely and accurate completion of all provider files.

· Assign and monitor workloads to meet departmental goals and service level agreements (SLAs).

· Provide ongoing coaching, performance feedback, and training to credentialing specialists.

· Support new team members through onboarding and mentoring.

Credentialing Operations

· Review and approve credentialing files prior to submission to payers or committees.

· Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state/federal guidelines.

· Coordinate initial credentialing, re-credentialing, and primary source verification processes.

· Assist in the maintenance and auditing of credentialing databases and systems (e.g., CAQH, Cactus, Verity, or other platforms).

· Respond to escalated provider and payer inquiries in a timely and professional manner.

Quality & Compliance

· Monitor quality control measures to ensure data accuracy and regulatory compliance.

· Prepare reports and metrics on credentialing performance, turnaround times, and productivity.

· Support internal and external audits and ensure corrective actions are implemented as needed.

· Stay current with evolving industry regulations and best practices.

Process Improvement & Collaboration

· Identify workflow gaps and lead process improvement initiatives.

· Collaborate cross-functionally with provider enrollment, contracting, and human resources teams.

· Recommend system enhancements and contribute to policy and procedure updates.

Qualifications:

Education & Experience

· Bachelor’s degree preferred (Healthcare Administration, Business, or related field).

· Minimum 3–5 years of experience in provider credentialing or medical staff services.

· At least 1–2 years of experience in a leadership, senior, or team lead capacity preferred.

Knowledge, Skills & Abilities

· In-depth understanding of credentialing standards (NCQA, URAC, CMS, and state requirements).

· Strong organizational and multitasking abilities with keen attention to detail.

· Excellent written and verbal communication skills.

· Proficiency in credentialing software and Microsoft Office Suite.

· Ability to lead, motivate, and develop team members in a fast-paced environment.

Job Type: Full-time

Pay: Rs70,000.00 - Rs110,000.00 per month

Application Question(s):

• Will you be able to work in night shift(6pm to 3am)?
• Will you be able to commute to Bahria Town Phase 7 Rawalpindi?

Work Location: In person