Credentialing Manager

This is a fully remote position, open to applicants in New York.

📋 Description

• Lead and oversee a team of Credentialing Interns, Associates, and Specialists, managing job assignments, performance evaluations, and professional growth while ensuring alignment with the organization's objectives.

• Approve timesheets, provide mentorship, and deliver strategic support to enhance team performance and guarantee operational success.

• Optimize operational processes associated with credentialing.

• Prepare and present detailed credentialing packets for the Credentialing Committee, which include flagged file reviews, logistics coordination, and credentialing KPI reporting.

• Act as a liaison with the Credentialing Verification Organization and Credentialing Supervisor to ensure timely completion of tasks, file management, and accurate system updates.

• Collaborate with credentialing stakeholders and the CVO to enhance outreach efforts, resolve discrepancies, and facilitate weekly meetings.

• Initiate and manage timely provider re-credentialing, including the review of quality and complaint data and provider documentation.

• Identify unresponsive, zero-caseload providers and process administrative terminations when necessary.

• Coordinate the scheduling and completion of clinician re-credentialing cycles with the CVO.

• Support delegated credentialing relationships with Enterprise clients and Account Management.

• Provide regular network update reports and monthly roster reports to Enterprise clients.

• Submit and track pre-delegation enrollment packets and their outcomes.

• Conduct regular audits of the CVO and quarterly internal Credentialing Program audits.

• Supply data for Enterprise client audits.

• Oversee the review of credentialed licenses and assist with ongoing monitoring documentation and reporting.

• Continuously evaluate and refine credentialing workflows and implement best practices.

• Perform other related duties as assigned.

⛳️ Requirements

• Bachelor’s Degree required (Master’s Degree preferred) or 7+ years of professional experience in credentialing or a related field.

• 4+ years of professional experience in a credentialing, compliance, or healthcare operations role, demonstrating team leadership and process management expertise.

• Strong experience in managing credentialing operations, including working with Credentialing Verification Organizations (CVOs) and handling delegated credentialing agreements.

• Familiarity with NCQA standards and guidelines as well as experience in policy and contract review to ensure compliance with these standards.

• Proven ability to manage cross-functional teams, lead projects, and streamline workflows to enhance efficiency.

• Exceptional communication, organizational, and problem-solving skills, with an emphasis on collaboration with both internal and external stakeholders.

• Experience in conducting audits, maintaining compliance with regulatory standards, and implementing process improvements.

• Proficient with credentialing software and systems, as well as skilled in reporting on credentialing metrics.

• Competent with Mac devices, Excel, Word, and Google Suite (sheets, docs).

🏝️ Benefits

• Comprehensive Medical, Dental, and Vision plans

• Pre-tax benefits: HSA/FSA

• 401k Retirement Savings Program with matching up to 4%

• Voluntary benefits including disability, basic life, or pet insurance, etc.

• Monthly Wellness Stipend to encourage mental and physical self-care

• Flexible PTO and a Remote First Environment

• Regular team events, including Wellness Workshops and Team Building Events

• Free access to Talkspace products for you and one household member, along with a friends and family discount!