Senior Manager of Credentialing Operations
2 months ago
POSITION SUMMARY/RESPONSIBILITIES
The Senior Manager of Credentialing Operations is responsible for the implementation and oversight of the credentialing and recredentialing processes for healthcare practitioners and providers. This role ensures compliance with regulatory and accreditation standards while monitoring and adapting to any changes in these requirements. The manager will collaborate with health plan partners to facilitate the verification process through the state Credentialing Verification Organization.
Additionally, this position involves coordinating research and generating reports for the Credentialing Committee regarding practitioners with credentialing issues, as well as liaising with licensing and monitoring organizations. The Senior Manager will work closely with the Chief Medical Officer or their designee to manage the Credentialing Committee and its activities.
EDUCATION/EXPERIENCE
A minimum of an associate degree in a healthcare-related or business management field is required, or alternatively, five years of relevant experience in similar roles. Candidates must possess strong written and verbal communication skills, along with problem-solving, organizational, statistical, and analytical capabilities. Familiarity with accreditation credentialing standards, such as those set by NCQA, as well as federal and state regulatory agency requirements regarding the verification of healthcare professional credentials, is essential. A preference will be given to candidates with at least five years of supervisory experience in a managed care environment, particularly those with exposure to diverse product lines and regulatory communications.
LICENSURE/CERTIFICATION
Certification from NAMSS as a Certified Provider Credentials Specialist (CPCS) is preferred.
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