About the Role
This role oversees the end-to-end provider credentialing process, driving accuracy, compliance, and operational efficiency while supporting organizational growth and quality standards.
Responsibilities
- Lead daily operations of provider credentialing to ensure timely and accurate processing
- Manage teams responsible for verifying provider qualifications and documentation
- Ensure adherence to federal, state, and payer-specific credentialing requirements
- Develop and refine standard operating procedures for credentialing workflows
- Monitor performance metrics and implement process improvements
- Collaborate with cross-functional teams to align credentialing with enrollment and onboarding
- Oversee audit readiness and respond to internal and external compliance reviews
- Maintain up-to-date knowledge of regulatory changes affecting provider enrollment
- Support system implementations and technology enhancements in credentialing platforms
- Train and mentor team members to ensure consistent, high-quality output
- Coordinate with legal and compliance teams on policy interpretation
- Resolve escalated credentialing issues and bottlenecks
- Ensure data integrity across provider databases and credentialing systems
- Drive timely completion of recredentialing cycles
- Partner with external vendors and third-party credentialing organizations
- Facilitate communication between regional teams and central operations
- Implement risk mitigation strategies for credentialing gaps
- Support provider data accuracy for network adequacy reporting
- Lead special projects related to credentialing process transformation
- Ensure consistent application of credentialing policies across all regions
Nice to Have
- Master's degree in healthcare administration or related field
- Credentialing certification such as CPCS or CPAM
- Experience in value-based care or primary care models
- Direct experience with Medicaid and Medicare enrollment
- Background in regulatory compliance audits
- Familiarity with EHR systems and data integration
- Leadership in healthcare transformation initiatives
- Experience with scaling operations in high-growth environments
- Knowledge of provider network design principles
- Track record of reducing credentialing cycle times
Compensation
Competitive salary and benefits package
Work Arrangement
Hybrid work model with both remote and on-site components
Team
Part of the provider operations team focused on scaling credentialing infrastructure
About the Team
- This position supports a rapidly expanding provider network committed to delivering high-quality, patient-centered care through a team-based model.
- The credentialing team plays a critical role in ensuring only qualified providers join the network, directly impacting patient safety and regulatory compliance.
Why This Role Matters
- Accurate and timely credentialing is essential for maintaining network integrity, supporting provider onboarding, and meeting accreditation standards.
- This leader will shape scalable processes that support national growth while upholding rigorous quality and compliance benchmarks.
Not available for this position
