Credentialing Operations Manager
About The Position
Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive. Watch this short video for a brief introduction to Paradigm. We are seeking a full-time, hybrid Credentialing Operations Manager that would be based out of our Tampa office. The Credentialing Operations Manager is responsible for overseeing and managing all aspects of the credentialing and recredentialing processes for clinicians and facilities. This role ensures that all providers and organizations meet regulatory and accreditation standards, and that all credentialing activities are executed efficiently, accurately, and in a timely manner. The Credentialing Operations Manager also leads delegation audits and partners with internal and external stakeholders to maintain the highest quality standards.
Requirements
- Bachelor’s degree in healthcare administration, business, or a related field (master’s preferred).
- Minimum of 3–5 years of experience in credentialing operations, with at least 2 years in a leadership or management role.
- Thorough understanding of credentialing requirements, accreditation standards, and regulatory guidelines (e.g., NCQA, URAC, CMS, The Joint Commission).
- Proficiency in Microsoft Office suite (Excel, PowerPoint, Word), data visualization tools (e.g. Power BI).
- Strong ability to analyze complex data sets and derive actionable insights.
- Exceptional written and verbal communication skills, with the ability to simplify complex topics for diverse audiences.
- Experience with credentialing software and data management systems.
- Proven ability to work collaboratively with cross-functional teams in a fast-paced environment.
- Strong focus on accuracy and thoroughness in all deliverables.
Nice To Haves
- Master’s degree
Responsibilities
- Oversee and manage the initial credentialing process for all clinicians (physicians, advanced practice providers, allied health professionals) and healthcare facilities.
- Ensure all applications and supporting documentation are collected, verified, and maintained according to organizational policies and regulatory requirements.
- Coordinate and communicate with providers, facilities, and internal teams to resolve discrepancies and expedite credentialing timelines.
- Lead and manage periodic recredentialing of clinicians and facilities in compliance with organizational, state, and federal guidelines.
- Monitor upcoming recredentialing deadlines and proactively communicate with providers and facilities to ensure timely completion.
- Analyze data and develop process improvements to streamline recredentialing activities and enhance compliance.
- Develop and implement audit tools and protocols to assess delegated entities' compliance with credentialing standards.
- Conduct regular delegation audits, document findings, and report results to leadership and relevant stakeholders.
- Provide guidance and corrective action plans for delegated entities not meeting performance or compliance expectations.
- Maintain and update credentialing and recredentialing policies to reflect current regulations and best practices.
- Train and support credentialing staff on policies, procedures, and regulatory changes.
- Ensure all credentialing activities align with NCQA, URAC, The Joint Commission, and other relevant accreditation standards.
- Prepare for and participate in internal and external audits and surveys.
- Act as a primary point of contact for credentialing inquiries from providers, facilities, internal departments, and regulatory agencies.
- Provide regular updates and reports on credentialing status, compliance metrics, and audit outcomes to senior leaders.
- Mentor, train, and supervise team members directly and indirectly, review their work and provide effective constructive feedback to achieve their best performance and goal attainment
- Set the tone for a strong Enterprise culture and high employee engagement.
- Ensure all team members understand, are trained in, and comply with Paradigm’s security requirements and policies.
- Ensure all team members have the minimum level of IT system access required to effectively complete their Paradigm responsibilities.
Benefits
- PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
- Competitive salaries
- 401(k) matching contributions
- Employer-paid life and disability insurance
- Flexible spending and commuter accounts
- Employer-matched HSA contributions
- Paid time off
- Personal holiday programs
- One paid day of volunteer time per calendar year
- Learning Excellence at Paradigm (LEAP) program
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What This Job Offers
Job Type
Full-time
Career Level
Manager
