Credentialing Lead

POSITION SUMMARY:

The Credentialing Lead is a highly specialized role focused on enrolling mental health providers into insurance networks, tracking state licenses, and responsible for overseeing and supporting the end-to-end credentialing process for eligible providers at all levels with contracted health plans. This role works collaboratively with Clinical, Billing, Human Resources, and Onboarding to maintain accurate participation status with all contracted health plans. The position requires strong skills in communication, CAQH, PAVE and Availity. A key focus of this role is ensuring data is consistently documented and maintained across all data sources and platforms, internally and externally, enabling more effective and scalable analytics across the organization.

This role reports to the Director of Contracting and Credentialing to deliver reporting and analysis that supports day-to-day operations and ongoing performance improvement.

JOB DUTIES & RESPONSIBILITIES:

Key Responsibilities Provider Enrollment

• Support and execute provider enrollments with all contracted health plans.
• Develop, maintain, and enhance the provider credentialing certification and enrollment processes
• Produce recurring and ad hoc reports to support credentialing operations.
• Ensure accuracy and consistency of reported data through validation and reconciliation processes.

Data Systems Documentation and Structure

• Maintain internal data reporting systems, provider attestation(s), including external data sources (e.g., CAQH, Availity and health plan provider portals).
• Maintain initial and reappointment provider credentialing
• Identify gaps or inconsistencies in data structures and escalate opportunities for improvement.
• Support the development and maintenance of data dictionaries and internal documentation resources.

Cross-Functional Support

• Liaison efforts externally with health plans and internally with including Human Resources, Onboarding, Billing, and Clinical Operations to streamline provider credentialing efforts.
• Present findings in a clear, concise manner appropriate for both administrative and clinical audiences.
• Perform regular audits to identify and report data inconsistencies and positive/negative trends.