Credentialing Operations Leader

Aspirion; Las Vegas (NV); On-site; USD 90,000 - 120,000; Full time

Job summary

Aspirion is seeking a Manager, Credentialing to lead the credentialing function, ensuring timely credentialing and recredentialing in line with payer and regulatory requirements. You will develop the team, manage daily workflows, and coordinate with internal and external stakeholders to minimize delays and maintain accuracy.

You will drive process improvements, oversee verification of licenses and certifications, and ensure HIPAA and NCQA standards compliance while partnering with Operations,

Qualifications

• Bachelor's degree preferred in healthcare administration, health information management, or a related field.
• Minimum three years of credentialing, provider enrollment, healthcare operations, or related experience.
• Minimum two years of supervisory or management experience preferred.

Responsibilities

• Demonstrate and promote Aspirion's mission, vision, and core values in all interactions.
• Provide leadership, direction, coaching, and support to Credentialing Specialists and Lead Credentialing Specialists.
• Oversee daily credentialing operations, including initial credentialing, recredentialing, payer enrollment, provider demographic updates, and maintenance of provider records.
• Establish and monitor team performance expectations related to productivity, quality, accuracy, turnaround times, and service-level requirements.
• Review operational reports and key performance indicators to identify trends, risks, and opportunities for improvement.
• Ensure credentialing applications and documentation are complete, accurate, and submitted within required timelines.
• Monitor provider credentialing and enrollment status and proactively identify potential delays or barriers.
• Serve as an escalation point for complex credentialing issues, payer discrepancies, and provider enrollment concerns.
• Research and resolve credentialing issues by partnering with payers, providers, clients, and internal departments.
• Ensure all provider information and credentialing documentation is maintained accurately and securely.
• Oversee the verification of provider credentials, including licenses, certifications, education, training, work history, sanctions, exclusions, malpractice coverage, and other required information.
• Ensure credentialing activities are completed in accordance with payer requirements, regulatory standards, client expectations, and company policies.
• Partner with internal teams to resolve credentialing-related issues.
• Develop and implement process improvements that increase efficiency, reduce errors, and improve credentialing turnaround times.
• Identify opportunities for automation, standardization, and workflow optimization.
• Lead and support the implementation of new credentialing processes, payer requirements, systems, and client initiatives.
• Conduct regular one-on-one meetings, team meetings, coaching sessions, and performance reviews.
• Support recruitment, onboarding, training, and development of credentialing teammates.

Skills

Credentialing leadership

Provider enrollment

Healthcare operations

Team coaching

Analytics

Microsoft Excel

Education

Bachelor's degree in Healthcare Administration or related

High school diploma or equivalent

Tools

CAQH

PECOS

NPPES

Job description

Aspirion is seeking a Manager, Credentialing to lead the credentialing function, ensuring timely credentialing and recredentialing in line with payer and regulatory requirements. You will develop the team, manage daily workflows, and coordinate with internal and external stakeholders to minimize delays and maintain accuracy.

You will drive process improvements, oversee verification of licenses and certifications, and ensure HIPAA and NCQA standards compliance while partnering with Operations,