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Role Description

The Vice President of Credentialing Operations will be responsible for overseeing and managing all credentialing operations functions across the organization; this includes developing and implementing credentialing policies and procedures, ensuring compliance with federal and state regulations, and maintaining positive relationships with healthcare providers. Leads a team to verify provider credentials, onboard providers efficiently, and optimize the credentialing process.

Duties & Responsibilities

• Oversee all credentialing operations and functions, ensuring timely and accurate primary source verification of credentials in a SaaS environment.
• Develop, implement, and optimize credentialing policies, procedures, and systems to maximize efficiency and maintain compliance.
• Lead and mentor a credentialing team, providing guidance and oversight to meet department goals and service level agreements.
• Serve as an expert and thought leader on credentialing regulations, trends, and best practices.
• Build and maintain positive relationships with providers and cross-functional teams.
• Manage credentialing budget and resources to meet organizational objectives.
• Ensure the accuracy and integrity of the provider database and directories.
• Identify opportunities for process improvement and implement changes to streamline credentialing.

Qualifications

• Bachelor's degree.
• 10 years of experience in healthcare credentialing, with at least 5 years in a leadership role in a SaaS environment.
• Expert knowledge of NCQA, CMS, federal, and state credentialing regulations and standards.
• Proven track record of developing and managing a high-performing credentialing team.
• Strong project management skills with the ability to lead process improvement initiatives.
• Excellent communication and relationship-building skills with both internal and external stakeholders.
• Proficiency in credentialing software and databases.
• Strong process improvement background in a large-scale BPO environment.
• Demonstrated ability to build, monitor, and execute on customer SLA’s to drive a seamless customer experience.

Desired Skills and Qualifications

• Master’s degree.
• Experience with delegated credentialing models.
• Lean Six Sigma or other process improvement certification.
• Active NAMSS, CPCS, or CPMSM certification.
• Experience credentialing providers in multiple states.
• Knowledge of provider enrollment and network management.

Compensation

• Min: USD $210,000.00/Yr.
• Max: USD $220,000.00/Yr.
• Please note the posted range for this role is the base salary range, this role also has a performance bonus structure.