Lead Credentialing

HealthRecon Connect India Private Limited provides technology-enabled Revenue Cycle Management (RCM) solutions to US healthcare providers. We leverage over 30 years of deep domain expertise, cutting-edge analytics as well as machine learning, Artificial Intelligence and Automated workflows to help improve cashflow, patient outcomes and enable peace of mind for our clients.

The Lead Credentialing is responsible for overseeing the provider credentialing and re-credentialing process, ensuring compliance with regulatory, payer, and organizational requirements. This role leads credentialing operations, supports team members, drives process improvements, and acts as the primary point of contact for provider enrollment and credentialing activities.

Role & responsibilities

• Lead and manage end-to-end provider credentialing and re-credentialing activities.
• Verify provider credentials, including licenses, certifications, education, training, work history, malpractice coverage, and board certifications.
• Ensure timely submission and follow-up of credentialing applications with insurance payers and regulatory bodies.
• Maintain accurate provider records in credentialing databases and systems.
• Monitor credential expiration dates and ensure timely renewals.
• Provide guidance, training, and support to credentialing team members.
• Review team performance and ensure adherence to established service level agreements (SLAs).
• Assist in workload management and resource allocation.
• Serve as an escalation point for complex credentialing issues.
• Ensure compliance with NCQA, CMS, Joint Commission, state, federal, and payer-specific requirements.
• Conduct regular audits of credentialing files and documentation.
• Develop and implement quality improvement initiatives.
• Maintain confidentiality and security of provider information.
• Generate and analyze credentialing reports and performance metrics.
• Identify process gaps and recommend operational improvements.
• Assist in developing and updating credentialing policies and procedures.

Preferred candidate profile

Any degree Business Administration, or a related field preferred.

• 6+ years of experience in provider credentialing, enrollment, or healthcare administration.
• Experience handling Medicare, Medicaid, and commercial payer credentialing.
• Strong knowledge of credentialing regulations and compliance requirements.
• Proficiency in credentialing software and Microsoft Office applications.

Shift: 7.30p.m to 4.30a.m IST

Work days: Monday to Friday

US Calendar is applicable

Interested candidates kindly send us your updated resume to [email protected]