Senior Credentialing Leader: Ops, Compliance & Strategy

Altais Health Solutions; Oakland (CA); On-site; USD 89,000 - 107,000; Full time

Benefits offered by this job

Medical coverage

Vision coverage

Dental coverage

401k match

Flexible time off

9 paid holidays

Job summary

Altais Health Solutions is seeking a senior credentialing leader to oversee all credentialing activities for our MSO and affiliated groups. You will manage application processing, primary source verification, and policy development to ensure compliance with NCQA, CMS, and DMHC standards.

You will build a high-performing team, drive audit readiness, and partner with health plan delegation teams to maintain strong provider data and reporting.

Qualifications

• Bachelor’s degree or equivalent to 4 year university degree is required.
• 10+ years of professional credentialing experience in a managed care setting is required.
• 2+ years of people management experience is required.
• Advanced knowledge of credentialing software and CRM tools and NCQA, CMS, and DMHC regulations is required.

Responsibilities

• Provide leadership and coaching to the credentialing team to ensure timely, accurate processing of credentialing applications.
• Oversee audit preparation and ensure readiness for payor and governmental audits.
• Manage relationships with health plan delegation oversight teams and vendor systems.
• Develop and maintain credentialing policies, procedures, and training materials.
• Lead Credentialing Committee activities with agenda development, file prep, and meeting minutes.
• Perform pre-delegation and annual oversight audits of sub-delegated entities and monitor remediation.

Skills

Credentialing

Team leadership

Vendor management

Audit readiness

Policy development

Education

Bachelor’s degree or equivalent to 4 year university degree

Tools

Credentialing software

CRM tools

Job description

Altais Health Solutions is seeking a senior credentialing leader to oversee all credentialing activities for our MSO and affiliated groups. You will manage application processing, primary source verification, and policy development to ensure compliance with NCQA, CMS, and DMHC standards.

You will build a high-performing team, drive audit readiness, and partner with health plan delegation teams to maintain strong provider data and reporting.