Saisystems Technology
Website:
saisystems.com
Job details:
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 ProView, 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.
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