About the Role

We are looking for an experienced Team Leader – Provider Credentialing to lead and manage provider credentialing operations for US healthcare providers. The ideal candidate should have solid hands-on experience in Provider Enrollment, Credentialing, Re-Credentialing, CAQH, Payer Enrollment, Provider Data Management, and Enrollment Follow-up. The candidate will be responsible for managing the credentialing team, ensuring timely completion of applications, maintaining accuracy, meeting client SLAs, and resolving enrollment-related issues.

Key Responsibilities

- Lead, manage, and mentor a team of Provider Credentialing specialists.

- Oversee end-to-end provider credentialing and enrollment processes.

- Manage initial credentialing, re-credentialing, and payer enrollment activities.

- Review credentialing applications for completeness, accuracy, and compliance.

- Monitor and manage CAQH profiles, including initial setup, updates, attestations, and re-attestations.

- Handle provider enrollment with commercial insurance companies, Medicare, Medicaid, and other applicable payers.

- Monitor the status of applications and conduct timely payer follow-ups.

- Identify and resolve credentialing and enrollment discrepancies, rejections, and delays.

- Maintain accurate provider information, including licenses, DEA, NPI, taxonomy, malpractice insurance, board certification, and other required documents.

- Track provider credentialing and enrollment status using internal trackers and systems.

- Ensure timely completion of re-credentialing and license/credential renewals.

- Monitor expirables and ensure there are no gaps in provider participation or credentials.

- Review payer correspondence and take appropriate action on enrollment requests and issues.

- Coordinate with providers, clients, payers, and internal RCM teams to resolve credentialing-related issues.

- Prepare and review daily, weekly, and monthly operational reports.

- Monitor team productivity, quality, turnaround time, and SLA compliance.

- Conduct quality audits and provide feedback and coaching to team members.





- Train new team members and provide ongoing process training.

- Handle escalations and ensure timely resolution of complex credentialing issues.

- Identify process gaps and implement improvements to increase efficiency and reduce enrollment delays.

- Ensure compliance with HIPAA, payer requirements, and company/client policies.

Required Qualifications & Experience

- 5+ years of overall experience in Medical RCM. Minimum 3+ years of hands-on experience in US Medical Provider Credentialing and Enrollment.

- Prior experience as a Team Leader / SME / Senior Associate / Supervisor in Provider Credentialing is preferred.

- Strong knowledge of the US healthcare provider enrollment and credentialing process.

- Hands-on experience with:

- Provider Credentialing

- Provider Enrollment

- Re-Credentialing

- CAQH

- Medicare Enrollment

- Medicaid Enrollment

- Commercial Payer Enrollment

- NPI and Taxonomy

- License and DEA verification

- Provider demographic updates

- Payer follow-up

- Credentialing expirables and renewals

- Experience working with multiple insurance payers and payer portals.

- Good understanding of provider participation, effective dates, enrollment status, and payer contracting processes.

- Strong knowledge of credentialing documentation and requirements.

- Excellent communication and follow-up skills.

- Strong analytical and problem-solving abilities.

- Good proficiency in MS Excel and other standard office applications.

- Ability to manage multiple providers, payers, and deadlines simultaneously.

- Manage daily workload allocation across the credentialing team.

- Monitor individual and team productivity.

- Conduct regular quality checks and audits.

- Track team KPIs and SLA performance.





- Provide coaching, feedback, and performance improvement support.

- Escalate critical issues to management with appropriate analysis and recommendations.

- Ensure smooth communication between credentialing, billing, AR, and other RCM functions.

- Develop and maintain SOPs, process documentation, and training materials.

Key Performance Indicators (KPIs)

- Credentialing application accuracy

- Enrollment turnaround time

- CAQH completion and attestation status

- Payer enrollment success rate

- Re-credentialing completion rate

- Expirable/renewal compliance

- Payer follow-up TAT

- Application rejection/error rate

- Team productivity

- Quality/audit scores

- SLA compliance

- Client satisfaction

Preferred Skills

- Strong leadership and people-management skills

- Excellent written and verbal communication

- Strong organizational and follow-up skills

- Attention to detail

- Ability to handle high-volume credentialing operations

- Strong understanding of US healthcare and insurance processes

- Ability to independently handle escalations and complex enrollment issues

- Strong ownership, accountability, and problem-solving mindset

Benefits:

- · Fix Salary.

- · Paid Leaves.

- · No extra hour working.

- · Incentive based target system.

- · US Federal Holidays.

- · Fix week offs on Saturdays & Sundays.

- · Health Insurance.

- · No salary bar for right candidates.

- Opportunity to work with a growing US Medical RCM organization

- Leadership and career-growth opportunities

- Exposure to multiple US healthcare payers and provider types

- Professional and collaborative work environment

- Performance-based growth opportunities

Pay: ₹50,000.00 - ₹70,000.00 per month

Benefits

- Health insurance

- Life insurance

- Paid time off

Education

- Bachelor's (Required)

Experience

- Provider Credentialing and Enrollment: 5 years (Required)

- Medical RCM: 5 years (Required)

Language

- English (Required)

Shift availability

- Night Shift (Required)

Work Location: In person

📌 Credentialing Specialist - Team Lead (Ahmedabad)
🏢 Orient Healthcare Technology
📍 Ahmedabad