Credentialing Team Lead

Jobtailor; California (MO); On-site; USD 65,000 - 100,000; Full time

Job summary

Jobtailor seeks an experienced credentialing leader to guide associates, design scalable workflows, and drive timely credentialing and recredentialing across clinical, compliance, and billing teams.

You will manage CVO relationships, maintain provider data in Verifiable, and develop dashboards to monitor timelines and performance metrics. Travel to San Jose may be required a few times yearly.

Qualifications

• 3+ years of experience in healthcare credentialing, operations, or administrative support in a payer or provider setting.

Responsibilities

• Provide day-to-day guidance, training, and support to credentialing associates.
• Design, document, and implement scalable credentialing workflows and SOPs.
• Identify and troubleshoot inefficiencies in credentialing and recredentialing processes.
• Collaborate cross-functionally to ensure credentialing processes integrate with clinical, compliance, and billing teams.
• Manage relationship with CVO, Verifiable.
• Maintain accurate and up-to-date provider information in internal databases and Verifiable.
• Track application statuses, credentialing deadlines, and recredentialing timelines to ensure timely completion.
• Analyze and update processes to improve timelines.
• Liaise with CVO to resolve any issues or delays in the credentialing process.
• Develop and maintain dashboards, reports, and trackers related to provider credentialing and compliance.
• Analyze data to identify trends, delays, or potential risks in credentialing timelines.
• Provide regular updates to leadership on key metrics and process improvements.

Skills

Healthcare credentialing

Supervising credentialing associates

Operational leadership

NCQA credentialing

Excel/Sheets proficiency

CRM/credentialing software

Tools

Microsoft Excel/Google Sheets

CAQH

Verifable

Job description

Responsibilities

• Provide day-to-day guidance, training, and support to credentialing associates
• Design, document, and implement scalable credentialing workflows and standard operating procedures (SOPs).
• Identify and troubleshoot inefficiencies in credentialing and recredentialing processes.
• Collaborate cross-functionally to ensure credentialing processes integrate smoothly with clinical, compliance, and billing teams.
• Manage relationship with CVO (Credentialing Verification Organization), Verifiable
• Maintain accurate and up-to-date provider information in internal databases and Verifiable
• Track application statuses, credentialing deadlines, and recredentialing timelines to ensure timely completion.
• Analyze and update processes to improve timelines
• Liaise with CVO to resolve any issues or delays in the credentialing process.
• Develop and maintain dashboards, reports, and trackers related to provider credentialing and compliance.
• Analyze data to identify trends, delays, or potential risks in credentialing timelines.
• Provide regular updates to leadership on key metrics and process improvements.

Requirements

• 3+ years of experience in healthcare credentialing, operations, or administrative support in a payer or provider setting.
• 1+ years experience supervising credentialing associates
• Operational leadership and accountability
• Strong understanding of NCQA credentialing requirements and best practices.
• Proficiency with Microsoft Excel/Google Sheets and experience with CRM or credentialing software (e.g., CAQH, Verifable).
• Excellent organizational and communication skills, with the ability to manage multiple tasks and deadlines.
• Experience in behavioral health or mental health provider credentialing.
• Ability to work in the US, to travel to our San Jose, California offices up to three times per year and to an additional company offsite.

Certifications & Qualifications

• NCQA credentialing requirements