Senior Lead Credentialing Specialist

2 days ago

Karachi, Sindh, Pakistan 247 DDCT Full time $450,000 - $550,000 per year

Position Summary

We are seeking a highly experienced Senior Lead Credentialing Specialist to oversee, guide, and develop the credentialing department. This role is responsible for setting standards, training staff, and ensuring full compliance with payer, regulatory, and accreditation requirements across multiple states. The ideal candidate will combine deep technical expertise in credentialing and provider enrollment with proven leadership and mentoring skills. Extensive credentialing experience for providers in the states of Illinois and Ohio is required, along with exceptional communication skills to interact effectively with providers, payers, and internal teams.

Key Responsibilities

  • Department Leadership: Direct, mentor, and train the credentialing team; create development plans and provide ongoing coaching to elevate performance.
  • Strategic Oversight: Establish policies, workflows, and best practices to maintain a high-quality, efficient credentialing operation.
  • Full-Cycle Credentialing: Oversee all provider credentialing and re-credentialing activities for physicians, allied health professionals, and facilities.
  • Payer Enrollment Management: Lead complex enrollments with Medicare, Medicaid, and commercial insurance networks, ensuring timely approvals and renewals.
  • State-Specific Expertise: Manage and troubleshoot credentialing and payer enrollment specifically for Illinois and Ohio, ensuring compliance with each state's unique requirements.
  • Compliance & Quality: Ensure adherence to state, federal, and accreditation standards (e.g., NCQA, URAC, JCAHO, HIPAA) and maintain rigorous documentation standards.
  • Process Improvement: Identify gaps, recommend solutions, and implement technology or workflow enhancements to reduce turnaround times.
  • Cross-Functional Collaboration: Serve as the key liaison between providers, payers, operations, and senior leadership to resolve escalated issues.
  • Reporting & Analytics: Deliver regular status reports, KPIs, and audit findings to executive management and stakeholders.
  • Training & Knowledge Sharing: Develop training materials and conduct sessions to keep the team current on regulatory changes, payer policies, and credentialing best practices.

Requirements

  • Bachelor's degree in healthcare administration, business, or a related field (Master's preferred).
  • 7+ years of progressive credentialing experience, including at least 3 years in a senior, lead, or managerial role.
  • Mandatory experience with credentialing and provider enrollment for the states of Illinois and Ohio.
  • Extensive knowledge of provider enrollment, payer regulations, Medicare/Medicaid guidelines, and multi-state credentialing.
  • Demonstrated ability to train, mentor, and build high-performing teams.
  • Strong understanding of healthcare compliance standards and accreditation requirements.
  • Excellent verbal and written communication skills, with the ability to present information clearly to diverse stakeholders.
  • Proficiency with credentialing software systems and advanced MS Office skills.

Preferred Qualifications

  • CPCS or CPMSM certification strongly preferred.
  • Experience managing credentialing for large physician groups, hospital networks, or healthcare BPO/RCM operations.

*NOTE*

Competitive compensation offered, with a potential salary increase of 30–40% over current CTC, based on relevant prior experience.

Job Type: Full-time

Pay: Rs450, Rs550,000.00 per month

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