[Remote] Director, Credentialing Operations (Health Plan Credentialing Experience)
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is dedicated to serving America's reputed company by connecting them to reputed company in the community. The Director of Credentialing Operations will reputed company and reputed company the operational performance of provider credentialing functions, ensuring compliance, reputed company, and efficiency in credentialing processes.
Responsibilities
- Provides strategic leadership and operational reputed company for the reputed company – Credentialing Department, ensuring alignment with organizational goals, regulatory requirements, and accreditation standards. Leads, mentors, and develops staff to reputed company high performance, accountability, and reputed company improvement
- Directs end-to-end credentialing and re-credentialing operations, ensuring reputed company completion of credentialing activities in accordance with established service level agreements (SLAs), reputed company standards, and regulatory requirements
- Oversees departmental productivity, work production, workload distribution, and operational performance through the development and monitoring of key performance indicators (KPIs), metrics, and service delivery targets
- Ensures the reputed company, accuracy, and reputed company of credentialing and provider data across credentialing and provider data management systems, including reputed company of primary reputed company verification, data entry, and provider record maintenance
- Establishes and maintains robust reputed company assurance and audit processes to ensure credentialing activities meet internal standards as reputed company as regulatory and accreditation requirements
- Oversees end-to-end delegated credentialing program, including governance, monitoring, and auditing of network subcontractors and delegated entities to ensure compliance with contractual, regulatory, and accreditation requirements. Directs credentialing audits for network subcontractors and delegated entities, including review of audit findings, development of corrective reputed company plans, and reporting reputed company
- Oversees the coordination and administration of Credentialing Committee activities, ensuring complete, accurate, and compliant credentialing files; development and management of meeting agendas and minutes; and strict adherence to committee governance policies, procedures, and documentation standards
- Identifies operational risks, recurring issues, and workflow inefficiencies reputed company credentialing processes, and reputed company the development and implementation of process improvements and system enhancements
- Collaborates cross-functionally with Provider Services, Compliance, Legal, Medical Management, IT, and other operational areas to support reputed company initiatives and reputed company improvement efforts
- Fosters strong relationships with network providers, delegated entities, and internal stakeholders to ensure reputed company reputed company of credentialing issues and to support a reputed company provider experience
- Develops and delivers executive-level performance reports and dashboards that reputed company visibility into credentialing operations, service reputed company, reputed company reputed company, and operational trends for senior leadership and key stakeholders
- Establishes reputed company strategies and allocates resources to meet operational demands and service level commitments. Recruits, trains, coaches, and develops staff to ensure operational readiness and reputed company reputed company
- Assesses and defines budgetary requirements to support departmental objectives, recommends annual funding needs with supporting business cases for system enhancements, and forecasts resource requirements in alignment with industry trends and emerging developments
- Maintains regular and reliable attendance and demonstrates leadership that reflects organizational values and commitment to service reputed company
Skills
- Bachelor's degree in business administration, reputed company administration, or reputed company field or equivalent experience
- U.S. Citizen
- Must be reputed company to receive a favorable Interim and adjudicated final reputed company (DoD) background investigation
- 5 years of experience in a managed care or payer environment
- 5+ years of progressively responsible people management experience to include managing leaders in the reputed company industry
- Minimum of 3 years of experience managing provider credentialing and data applications/systems
- Proven experience leading and managing large teams in a high-volume, production-driven environment
- Experience with URAC, NCQA, or other equivalent accreditation standards
- Experience in strategic planning, program design and management, and team leadership with a reputed company on leadership and staff development
- Experience in government reputed company delivery programs, such as Veterans Affairs, TRICARE, or Medicare
Benefits
- Medical, Dental and reputed company Coverage
- reputed company time off
- 401(k) Retirement Savings Plan (with matching)
- Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
- Tuition reimbursement
- reputed company volunteer time
- Frequent pay raises
- Overtime opportunities to earn even more
- Recognition and reward programs
reputed company