Provider Operations Manager – Credentialing

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

📋 Description

• Assist with everyday credentialing operations, which includes managing queues, resolving complex cases, and enhancing turnaround times and quality.

• Document operational procedures clearly in standard operating procedures (SOPs) and maintain an up-to-date centralized documentation repository.

• Aid in managing and developing the offshore team through training, documentation, and monitoring quality and productivity.

• Collaborate on offshore transitions by identifying tasks that can be transferred and ensuring seamless handoffs.

• Evaluate operational challenges, leverage data to quantify opportunities, and create business cases for AI, technology, and offshore solutions.

• Design and implement AI solutions to enhance operational efficiency and scalability, collaborating with product and engineering teams as necessary.

• Assist with the 2027 CVO vendor transition, which includes workflow mapping, requirements gathering, testing, cutover, and vendor performance assessment.

• Become proficient in internal systems and tools, troubleshoot issues, and recommend improvements to system logic.

• Take ownership of operational metrics, develop reporting, identify trends and bottlenecks, and inform decisions with data insights.

• Ensure credentialing operations adhere to CMS, AAAHC, and state regulations.

• Collaborate with internal leadership, network and contracting teams, providers, vendors, and offshore partners.

⛳️ Requirements

• 3-5+ years of experience in operations, process improvement, or consulting.

• A proactive operator with a strong inclination towards action; ready to engage in tasks rather than merely overseeing them.

• A strong enthusiasm for efficiency and the ability to foresee and mitigate bottlenecks.

• Comfortable navigating between overarching strategy and detailed execution.

• Capable of quickly shifting focus and reprioritizing in a dynamic, fast-paced environment.

• Resilience in tackling complex and challenging problems.

• Detail-oriented, maintaining a high standard for quality and accuracy.

• Eagerness and capability to comprehend and adhere to intricate regulations.

• Excellent communication skills with the ability to collaborate with cross-functional stakeholders and drive alignment.

• Proficient in data, systems, and technology, capable of building reports that enhance decision-making.

• Experience in the healthcare sector.

• Knowledge of credentialing standards and CMS regulations.

• Practical experience in building and implementing AI tools to streamline workflows, or a strong history of applying technology and automation to operational challenges.

• Familiarity with process improvement methodologies.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.

• Generous paid time off.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available to all employees.

• Bonus eligibility for all positions except Director and above.

• Commission eligibility for Sales positions.

• Parental leave program.

• 401K program.