Senior Credentialing Leader — Compliance & Strategy

Altais; California, Northern (MO, KY); Hybrid; USD 89,000 - 107,000; Full time

Benefits offered by this job

Excellent medical, vision, and dental

401k with company match

Flexible time off

Job summary

Altais is seeking a senior credentialing leader to direct the strategic direction and operational oversight of our credentialing function across all MSO platforms and health plan partners. The role includes policy development, training, and performance reporting to ensure regulatory compliance and high-quality credentialing processes.

You will drive department training, vendor relationships, and audits while coordinating with the Credentialing Committee and the Chief Medical Officer to advance

Qualifications

• Bachelor’s degree or equivalent to 4 year university degree, preferably in healthcare related field.
• 10+ years professional experience working in credentialing, preferably in a managed care setting required.
• 2+ years of employee / team management experience.
• Requires advanced knowledge of credentialing software and CRM tools plus expert working knowledge of NCQA, CMS Conditions of Participation, Medicare Advantage requirements, and DMHC regulations, including delegation oversight and audit readiness.
• Required Certifications Must be eligible to take National Association Medical Staff Services (NAMSS), Certified Provider Credentialing Specialist exam within 18 months of employment NAMSS Credentialing certification preferred.

Responsibilities

• Provide leadership / coaching to the credentialing team staff, ensuring function initiatives and deliverables are complete and accurate in a timely manner.
• Responsible for processing credentialing applications accurately and promptly in accordance with Credentialing policies and procedures and in full compliance with all regulations with a continued focus on delivery of a high-quality product with the greatest level of efficiency
• Manages audit preparation of materials and files necessary to comply with external audits by payors and/or governmental agencies
• Manages relationships with health plan delegation oversight teams
• Manages peer review physician documentation for Clinical Advisory Group
• Develops, maintains, and annually reviews credentialing training documents, desktop procedures, and onboarding materials for the credentialing team
• Conduct audits of the credentialing database, confirming accurate input of provider data, and verifying accuracy of modifications made to the database and downstream impacts to other reporting tools and functions
• Owns Credentialing Database system modifications and workflows development and implementation
• Manages vendor systems and services performance
• Leads credentialing committee effectiveness in partnership with the Chief Medical Officer
• Prepares and facilitates the Credentialing Committee, including agenda development, file preparation and presentation, meeting minutes, and follow-through on committee determinations
• Conducts pre-delegation and annual oversight audits of sub-delegated entities, evaluates compliance against NCQA, CMS, and DMHC requirements, issues corrective action plans, and monitors remediation to closure
• Owns the credentialing policy portfolio, including annual review, revision, and approval routing of policies and procedures to maintain alignment with regulatory and accreditation standards
• Develops key performance indicators for the credentialing function and creates recurring dashboards and ad hoc reporting for executive leadership
• Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities for Altais Health affiliated groups as well as clients purchasing MSO services
• Identifies and resolves technical, operational and organization problems outside own team
• Other duties as assigned

Skills

Leadership

Credentialing

Team management

Vendor management

Education

Bachelor's degree

Tools

NAMSS software

CRM tools

Job description

Altais is seeking a senior credentialing leader to direct the strategic direction and operational oversight of our credentialing function across all MSO platforms and health plan partners. The role includes policy development, training, and performance reporting to ensure regulatory compliance and high-quality credentialing processes.

You will drive department training, vendor relationships, and audits while coordinating with the Credentialing Committee and the Chief Medical Officer to advance