Job Description
Job Summary:
The Manager, Provider Credentialing Operations Implementation is responsible for managing provider credentialing processes for new market implementations within a managed care organization. This position will ensure that all providers meet necessary standards, comply with regulatory requirements, and are efficiently onboarded and maintained within the system.
Essential Functions:
Manage and lead a team of credentialing specialists to ensure the timely and accurate credentialing of healthcare providers
Design and implement credentialing policies, workflows, and procedures that ensure compliance with applicable regulatory standards (e.g., NCQA, URAC) and contractual obligations
Lead projects related to the initial setup and ongoing maintenance of provider credentialing operations and ensure all systems and processes are optimized for efficiency and compliance
Monitor the credentialing process to ensure all regulatory and internal compliance requirements are met
Work closely with other departments to ensure smooth implementation and execution of credentialing processes and serve as the key point of contact for provider credentialing inquiries and issues
Develop and deliver training programs for team members and internal stakeholders on provider credentialing policies, systems, and best practices
Prepare and present regular reports on credentialing status, performance metrics, and any issues related to provider onboarding and credentialing
Continuously evaluate the provider credentialing process and recommend improvements to increase operational efficiency, reduce processing time, and enhance provider satisfaction
Perform any other job duties as requested
Education and Experience:
Bachelor's degree in Healthcare Administration, Business Administration, a related field or equivalent years of relevant work experience
Five (5) years of experience in managing credentialing operations is required
Previous leadership experience is required
Experience with credentialing software systems and the use of electronic tools for managing provider data
Experience with provider data application within Cognizant Facets system
Competencies, Knowledge and Skills:
In-depth knowledge of provider credentialing regulations, policies, and procedures within managed care organizations
Skilled in process improvement and project management
Ability to lead, mentor, and motivate a team to achieve goals and meet deadlines. Strong decision-making and problem-solving capabilities
In-depth knowledge of credentialing processes, regulations, and industry standards, including NCQA, URAC, CMS guidelines, and state-specific requirements
High level of accuracy and attention to detail, ensuring all provider information is thoroughly vetted and compliant
Strong verbal and written communication skills
Ability to present complex information in a clear and concise manner to both internal stakeholders and external partners
Proficient in managing multiple projects simultaneously, balancing priorities, and maintaining timelines
Familiarity with credentialing software systems (e.g., Cactus, CAQH, Verity, or similar platforms), along with MS Office Suite (Excel, Word, PowerPoint)
Ability to identify issues and implement effective solutions, balancing operational efficiency with regulatory compliance
Strong focus on customer service, both for internal and external stakeholders
Ability to analyze and interpret data, track performance metrics, and make data-driven recommendations for improvement
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Occasional travel may be required
Compensation Range:
$81,400.00 - $130,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.
