About Zealie LLC
Zealie is a fast-growing Medical Billing company specializing in the Behavioral Healthcare industry. Our clients are substance use disorder treatment, addiction recovery, and mental health treatment centers that are saving lives on a daily basis. Our state of the art proprietary technology provides data analytics and revenue prediction tools to our clients to help them make strategic business decisions to grow their business. We are committed to delivering exceptional products and services to our clients and believe that our team plays a crucial role in achieving this mission. We are seeking motivated individuals with a desire to be a part of a winning team.
Job Summary
Reporting to the Payer Relations Manager, the Credentialing Performance Lead is accountable for the accuracy, pace, and results of credentialing and payer enrollment work for behavioral health facilities across the United States. The Lead sets and tracks performance goals for a group of Credentialing Specialists, personally works the most complex and aged cases, and explains case status to clients and internal teams with clarity and ownership. We are looking for experienced credentialing professionals who are ready to take responsibility for a team's results as well as their own caseload. The role carries a path to Team Lead and Manager positions
for those who perform well.
Responsibilities and Duties
Team performance and accountability
• Set daily and weekly productivity and quality targets for assigned Credentialing Specialists, track results in the team's credentialing log, and report them to the Payer Relations Manager each week
• Make sure every open request shows activity and an updated status at least once a week; follow up with owners on aging items and escalate any that miss this standard
• Hold regular one-on-ones with Specialists, document performance gaps, and follow through on improvement plans
• Review applications and forms before submission and track the team's first-pass accuracy
• Identify, correct, and redirect tasks that were worked incorrectly or routed to the wrong person
Complex and aged cases
• Personally work stalled, rejected, and aged requests, including items pending 180+ days, across non-participating (non-par) credentialing, In-Network (INN) contracting, EFT enrollment, and ERA enrollment
• Escalate within payer organizations (provider relations, network management, executive contacts) and outside them, for example through state insurance department complaints, when standard follow-up has stopped producing results
• Decide when a request should be escalated, re-submitted, or placed on hold instead of repeating steps that have not worked
• Keep a dated history on every case with evidence linked: call reference numbers, emails, fax confirmations, and submitted forms
Client and internal communication
• Explain credentialing and contracting status to clients and Customer Success Managers with clarity, empathy, and ownership, including what non-par status means for reimbursement and admissions
• Participate in client meetings on payer portals, INN applications, and credentialing requirements, and close out the action items that come from them
• Respond to payer, client, and internal emails within 2 business days, and review client-facing emails drafted by Specialists before they are sent
• Work with the Payer Relations Manager, Collections, Billing, and Customer Success teams to meet project deadlines
Training and process knowledge
• Train new hires on Payer Relations workflows, tools, and expectations, and run follow-up and recap sessions on specific request types and complex payer workflows
• Coach Specialists to understand why each step in a workflow exists, so they can handle payer requests that the SOP does not cover
• Write and maintain payer-specific and state-specific SOPs so that process knowledge is documented and shared across the team
• Identify process gaps and recommend improvements to workflows, trackers, and tools
General
• Maintain confidentiality of all patient and client information to ensure patient rights are protected
• Perform additional duties as requested by the Management team
Qualifications and Skills
• Strong understanding of credentialing, contracting, and payer enrollment workflows, including facility (organizational) credentialing
• Working knowledge of CAQH, NPPES, PECOS, and payer portals such as Availity
• Proven ability to lead a team: setting targets, reviewing work, giving direct feedback, and holding people accountable
• Sound judgment on complex or unusual payer requests, and the ability to identify process gaps and provide corrective guidance
• Excellent spoken and written English, with the confidence to handle client calls and escalation emails
• Strong organizational and analytical skills, including comfort with productivity, quality, and aging metrics
• Proficiency in Google Workspace (Gmail, Drive, Sheets, Docs) and the ability to navigate multiple technology platforms
• Ability to manage team oversight, a personal caseload, and projects at the same time
Education and Experience
• Bachelor's degree or higher in any stream
• Minimum 5 years of experience in US healthcare credentialing and payer enrollment
• Minimum 2 years as a Team Lead, Supervisor, SME, or Senior Credentialing Associate with responsibility for other team members' work quality or productivity
• Minimum 2 years of Behavioral Health & Mental Health credentialing experience
• Hands-on experience with payer portals, INN applications, and credentialing documentation
Preferred
• NAMSS CPCS certification, or eligibility to sit for it
• Experience with in-network contracting, single case agreements, and fee schedule terms
• Experience leading teams in an offshore delivery model supporting US healthcare clients
• Working knowledge of state credentialing guidelines for CA, AZ, TX, FL, NJ, CO, and HI
• Experience managing 25+ clients simultaneously and handling 280+ credentialing requests per week
• A record of reducing errors and turnaround times on a team they led