General Summary

Leads the Credentialing business line and oversees day-to-day credentialing operations to ensure timely, compliant credentialing and recredentialing outcomes. Responsible for staff leadership, process governance, performance management, and collaboration with clinical and operational stakeholders to support safe practice and organizational needs.

Duties and Responsibilities

Essential Functions:

Plans, directs, and monitors credentialing operations to ensure compliance with organizational policy and applicable requirements.Leads, coaches, and evaluates credentialing staff. Oversees hiring, onboarding, training, scheduling, and performance management.Monitors operational performance (e.g., backlog, turnaround times, quality indicators) and implements corrective actions and continuous improvement initiatives.Ensures integrity of credentialing data within systems and coordinates with IT/IS partners as needed for reporting.Supports internal and external audits and accreditation/compliance reviews. Develops and tracks corrective action plans as needed.Maintains and updates quality-related policies, procedures, and work instructions in collaboration with department leadership.Develops and delivers routine reporting to leadership, including key risks, trends, and operational outcomes.

Common Expectations:

Develops, establishes and implements goals, objectives, and policies and procedures for department/service line/entity operation, and which guide and support the provision of the department/service line/entity's services.Recommends staffing levels, selects and assigns staff, evaluates performance, evaluates/tests competencies (as applicable), provides orientation, training and continuing education of staff, and initiates or makes recommendations for personnel actions.Coordinates and integrates services within the department/service line/entity, with other departments/service lines/entities, and with the System's primary functions. Participates in the selection of outside services (if needed).Continuously assesses and improves the department/service line/entity/System's performance. Maintains appropriate quality control/assessment programs (if applicable).Compiles data for and prepares regularly scheduled or special reports, analyses and statements.Develops and manages department budget and ensures department operates within budget.Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.

Qualifications

Minimum Education:

High School Diploma or GED RequiredBachelors Degree or higher in a related field Preferred

Work Experience:

7 years Progressive experience in provider credentialing/medical staff services, including at least 2 years of people leadership or equivalent supervisory experience RequiredExperience leading credentialing operations in a large health system and supporting committees and/or audit activities Preferred

Licenses:

Certified Provider Credentialing Specialist Upon Hire Preferred orCertified Professional Medical Services Management Upon Hire Preferred

Knowledge, Skills, and Abilities:

Strong attention to detail and ability to manage multiple priorities while meeting deadlinesProficiency with Microsoft Office (Outlook, Excel, Word) and ability to learn credentialing/enrollment systemsEffective written and verbal communication skills with providers, payers, and internal stakeholdersAbility to interpret policies, procedures, and payer/agency requirements and apply them consistentlyDemonstrated discretion and ability to maintain confidentiality of sensitive informationDemonstrated leadership skills, including change management, performance management, and stakeholder communication

Benefits Offered:

Comprehensive health benefitsRetirement savings planPaid time off (PTO)Education assistanceFinancial education and support, including DailyPayExpanded Paid Parental Leave

For additional details:

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