Remote Credentialing Operations Lead

Oscar Health; United States; Remote; USD 65,000 - 94,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

11 paid holidays

Paid sick time

Paid parental leave

401(k) plan participation

Life and disability insurance

Paid wellness time and reimbursements

Job summary

Oscar Health is seeking an Associate Manager, Credentialing Operations to lead a credentialing team and ensure timely provider credentialing and re-credentialing. You will manage production, quality, SLAs, and escalations while driving process improvements and risk mitigation.

The role reports to the Senior Manager, Provider Operations Credentialing and is fully remote for U.S. residents (excluding several states).

Qualifications

• 3+ years of direct people management experience.
• 2+ years of experience in provider credentialing, re-credentialing, provider enrollment, or a closely related function.
• 3+ years of healthcare operations experience supporting high-volume production teams.
• 1+ year experience using data to drive decision making and continuous improvement.
• Strong proficiency navigating Excel/Google Sheets, JIRA, and/or SQL.
• Working knowledge of credentialing standards and requirements, including NCQA, CMS, state, and delegated-credentialing requirements.
• Experience supporting process improvement initiatives cross-functionally.
• Bachelor’s Degree.
• Experience leading credentialing operations for a health plan, health system, provider organization, or credentials verification organization.
• Prior healthcare or insurance-related experience.

Responsibilities

• Evaluates overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies
• Lead the day-to-day credentialing operation, including workload planning, queue management, service-level performance, quality, and issue resolution
• Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
• Conduct root-cause analysis on systemic issues and construct action plans to address
• Maintains, analyzes, and communicates reporting on assigned team KPIs. Track monthly and quarterly to meet departmental objectives
• Hire and manage a team of Oscar colleagues with direct responsibility for performance management, their growth and development, and associated HR administrative tasks
• Compliance with all applicable laws and regulations
• Other duties as assigned

Skills

People management

Credentialing

Healthcare operations

Data-driven decision making

Excel/Google Sheets

JIRA

SQL

NCQA knowledge

Cross-functional collaboration

Bachelor’s Degree

Healthcare/insurance experience

Education

Bachelor’s Degree

Tools

JIRA

SQL

Excel/Google Sheets

Job description

Oscar Health is seeking an Associate Manager, Credentialing Operations to lead a credentialing team and ensure timely provider credentialing and re-credentialing. You will manage production, quality, SLAs, and escalations while driving process improvements and risk mitigation.

The role reports to the Senior Manager, Provider Operations Credentialing and is fully remote for U.S. residents (excluding several states).