Credentialing and Regulatory Operations Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Take full ownership of the comprehensive strategy and execution for provider credentialing, re-credentialing, supervising physician management, privileging, and licensing on a large scale.

• Ensure adherence to CMS, NCQA, Joint Commission, state licensing boards, and specific payer requirements.

• Supervise primary source verification pertaining to education, training, licensure, board certification, DEA, sanctions, and work history.

• Manage the maintenance of relationships and agreements with supervising/collaborating physicians.

• Act as a liaison among providers, supervising physicians, clinical leadership, regulatory agencies, and internal departments.

• Collaborate with Compliance, Legal, Revenue Cycle, Provider Operations, and Clinical Leadership on onboarding, payer enrollment, and go-live readiness.

• Coordinate credentialing data for payer enrollment, revalidation, and re-credentialing processes.

• Create, implement, and uphold credentialing policies, procedures, and workflows.

• Perform internal audits and engage in accreditation surveys, audits, and regulatory reviews.

• Lead, mentor, and develop team members.

• Design and enhance team workflows.

• Act as a subject matter expert and main point of escalation for complex operational challenges.

• Identify and escalate credentialing, licensing, supervision, or compliance risks.

• Manage credentialing systems and tools, including Modio, Symplr, Helix, or comparable platforms.

• Oversee credentialing cycles, expirations, and renewals.

• Establish and track operational metrics.

• Develop dashboards, reports, and tracking systems.

• Generate insights and reporting to support leadership decisions, capacity planning, and process enhancements.

⛳️ Requirements

• Bachelor’s degree in healthcare administration, business administration, or a related field (or equivalent experience).

• A minimum of 3 years of progressive experience in provider credentialing, licensing, or medical staff services.

• At least 2 years of supervisory or management experience.

• Comprehensive knowledge of credentialing standards (NCQA, Joint Commission, CMS).

• Strong understanding of provider credentialing, privileging, and licensing obligations.

• Proven leadership and team management capabilities.

• Exceptional attention to detail along with strong organizational skills.

• Ability to interpret intricate regulations and implement them operationally.

• Excellent written and verbal communication skills.

• Proficient in credentialing software and Google applications.

• Capacity to juggle multiple priorities and adhere to deadlines in a fast-paced setting.

• Applicants must be legally authorized to work in the country where the position is based at the time of application.

🏝️ Benefits

• Flexible vacation.

• Sick leave.

• 12 statutory holidays.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Disability insurance.

• Life insurance.

• Mental health programs.

• Employee Assistance Program (EAP).

• RRSP/401(k) program with company match.

• Annual reimbursement for eligible training and professional programs.