Enrollment & Credentialing Lead

Medrevn is seeking an experienced Enrollment & Credentialing Lead to oversee and guide a team of 20 credentialing specialists. This leadership role requires hands-on management of the entire credentialing and enrollment processes for providers with Medicare, Medicaid, and commercial payers. The ideal candidate will bring over three years of US healthcare credentialing experience, strong knowledge of industry portals such as CAQH, PECOS, and NPPES, and the capability to manage multiple applications efficiently while ensuring compliance and seamless provider access to payer networks. In this position, you will act as the primary point of contact for credentialing activities, including credentialing, re-credentialing, enrollment, and demographic updates. You will maintain accurate documentation, track critical license and certification expirations, and coordinate with billing teams to mitigate claim denials related to credentialing. Your leadership will be pivotal in maintaining high standards across multiple client accounts, reporting progress to internal stakeholders, and fostering a motivated team environment that supports professional growth and company success.
Responsibilities

Lead, train, and manage a team of 20 credentialing specialists, assigning daily tasks and monitoring workload to ensure timely completion.
Oversee provider enrollment for Medicare, Medicaid, and commercial payers across multiple states from application to approval.
Maintain and update CAQH profiles, manage NPPES (NPI), PECOS, and various payer portal applications accurately and promptly.
Process re-credentialing, revalidations, demographic changes, and additions of providers to group contracts ensuring compliance with payer requirements.
Proactively follow up with payers on pending applications, efficiently resolve delays, rejections, and prevent credentialing-related issues.
Track expiration of licenses, DEA registrations, board certifications, and malpractice insurance to ensure continuance of provider credentials.
Keep client credentialing trackers current, prepare status reports, and communicate progress updates to US clients and account managers.
Collaborate closely with the billing team to identify and prevent claim denials resulting from credentialing or enrollment discrepancies.
Utilize strong organizational skills to handle a high volume of credentialing applications and renewals concurrently ensuring accuracy.
Provide exceptional written and verbal communication in English to facilitate smooth interactions with US-based payers and clients.
Implement best practices and process improvements in credentialing and enrollment operations to optimize team efficiency and client satisfaction.
Support career development and professional training opportunities within the credentialing team to maintain a high-performance culture.