Senior Team Leader _ Provider Enrollment

Senior Team Leader – Provider Credentialing & Enrollment

Department:  Credentialing / Provider Enrollment

Experience:

6–10 Years

Location:

Chennai

Employment Type:

Full-Time

Shift:  US Shift / Night Shift

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 Pro View, 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.