Senior Credentialing Lead Job White Plains area,City of White Plains New York USA,Management

Location: City of White Plains

Full Time White Plains, NY, US

Salary Range: $55,000.00 To $65,000.00 Annually

Job Title:

Sr. Credentialing Lead

Reports to:

National Billing Manager

Position Summary:

The Sr. Credentialing Lead is accountable for the end to end performance, output, and compliance of the credentialing department. This role drives KPI attainment, enforces operational discipline, manages team productivity, and ensures all credentialing pipelines move efficiently from intake through approval.

This is a results driven leadership role measured by turnaround times, accuracy, client satisfaction, and adherence to regulatory and internal standards.

Key Performance Areas & Key Performance Indicators:
Credentialing Operations Management: (30%)

Own and drive all credentialing workflows across clients and payers
Oversee full lifecycle from intake through approval
Enforce standardized workflows across all specialists
Identify bottlenecks and implement process improvements
Ensure payer specific requirements are met on first submission

Data Integrity, Compliance & Credentialing Systems: (10%)

Oversee completion of all EFT, ERA, and EDI enrollments
Track enrollment status from submission through approval
Ensure alignment with billing systems and clearinghouse requirements
Troubleshoot enrollment issues and payer discrepancies
Maintain accurate records of confirmations and effective dates
Partner with billing and revenue cycle teams to prevent delays
Implement tracking systems to eliminate revenue impact from enrollment gaps

Team Performance & Productivity Management: (25%)

Manage team output and accountability
Conduct monthly audits across team members and clients
Assign and rebalance workloads based on priorities
Enforce accountability through corrective action plans
Lead daily and weekly production meetings
Train, mentor, and develop team members

Client Delivery & Satisfaction: (20%)

Ensure consistent service delivery across all accounts
Lead or oversee client communications
Provide weekly status reports with actionable insights
Manage escalations and resolve issues proactively
Align credentialing timelines with client expectations

Communication & SLA Enforcement: (15%)

Maintain strict internal and external communication standards
Ensure real time documentation of all updates and actions
Collaborate with billing, coding, and onboarding teams
Enforce structured communication protocols across the department

Minimum Qualifications

Education:

Associates Degree required
Bachelor’s Degree in Healthcare Administration, Business Administration, or related field preferred
CPCS certification preferred

Experience:

Minimum 4+ years in credentialing operations
3+ years in leadership or management role
Experience managing multi client credentialing portfolios
Strong knowledge of CAQH, NPPES, PECOS, and payer enrollment processes
Understanding of multi state credentialing requirements
Strong attention to detail and organizational skills
Excellent communication and interpersonal skills

Operations Knowledge –

Thoroughly understands the operational procedures for his/her position and how they affect or relate to other departments in the company. Serves as an expert for others.

Strategic Execution –

Capable of translating concepts into detailed plans and managing timelines with discipline and focus.

Compliance Knowledge

Extensive understanding of general and department-specific regulations. Serves as a compliance resource for the team.

Organization –

Maintains control of multiple priorities, builds systems that eliminate scheduling conflicts, and supports seamless daily flow.

Teamwork

– Able to build morale and group commitments to goals and objectives;
Balances team and individual responsibilities;
Exhibits objectivity and openness to others’ views;
Gives and welcomes feedback;
Contributes…