Director, Credentialing Verification Organization

HEALTHSTREAM INC•Nashville, TN

2d•$101,099 - $124,608•Remote

About The Position

Lead HealthStream's Credentialing Verification Organization (CVO) operations while partnering with Product Development to adopt and operationalize the next-generation credentialing suite. This role is responsible for maintaining NCQA certification and delivering high-quality credentialing services while driving operational improvements through new technology and process optimization.

Requirements

Bachelor's degree preferred. In lieu of degree, equivalent work history and years of experience will be considered.
CPMSM or CPSC professional certification required; both preferred.
Minimum 5 years leading credentialing operations at a CVO or large health system
Successfully led or significantly contributed to at least one NCQA accreditation survey cycle.
Strong working knowledge of NCQA, TJC, AAAHC, CMS, and delegated credentialing standards.
Experience with commercial credentialing software platforms; CredentialStream experience strongly preferred.
Demonstrated history of improving credentialing workflows, processes, or operational efficiency
Budget management experience including both revenue and expense accountability.
Experience adopting new technology or leading operational teams through system transitions.
Comfortable partnering with Product Development teams to define requirements and validate solutions.
Familiarity with data and reporting tools to support operational decision-making; experience with BI/analytics platforms a plus.
Project management experience sufficient to manage cross-functional initiatives.
Strong written and verbal communication skills — able to engage credibly with both frontline staff and executive leadership.
Sound judgment and decision-making skills
Deals effectively and calmly with conflict related and/or emotional situations.
Possesses critical thinking and problem-solving skills.
Ability to balance operational continuity with change initiatives
Ability to lead and motivate teams
Ability to track and measure staff performance
Ability to delegate and assign work to others
Ability to plan, organize and manage multiple projects and set priorities.
Able to maintain and develop effective working relationships with clients, providers, leadership, department staff and contacts inside and outside of the CVO
This position is primarily sedentary in a normal office environment. Extensive computer usage and use of the phone. Could lift up to 20 lbs.
Accountability - Taking responsibility for one’s actions and the consequences that result from those actions.
Communication & Positive Presence - Listening attentively and respectfully; expressing thoughts and ideas effectively and concisely—both verbally and in writing. Exhibiting a pleasant attitude.
Collaboration - Cooperating and working effectively with others in the pursuit of common goals.
Problem Solving - Using sound judgment, logic, and common sense to identify and/or resolve issues that involve clients/customers, products, and processes.
Adaptability - Being flexible and continuing to function effectively during times of change.
Organizing - Using effective methods for tracking project details, time, and resources in order to complete tasks efficiently and in a timely manner.
Quality Focus - Acting diligently to ensure all aspects of work are completed accurately.
Customer Service - Treating clients/customers with a high level of respect and taking action in order to meet or exceed expectations and resolve problems.

Responsibilities

Provide strategic leadership to the CVO.
Direct all CVO credentialing operations, ensuring adherence to NCQA certification standards, delegated credentialing requirements, and client-specific SLAs
Chair the CVO Quality Committee and own the quality management program including corrective action and continuous improvement
Lead NCQA survey preparation and maintain survey-ready operations year-round; act as a liaison with the NCQA, TJC and related accreditation organizations.
Serve as subject matter expert on credentialing standards and maintain working knowledge of regulatory requirements from NCQA, TJC, AAAHC, and related accrediting organizations; translate regulatory changes and industry best practices into operational policy updates.
Partner with the Operations Manager to ensure day-to-day operational continuity, staff development and workload management
Develop and maintain CVO policies, procedures, training and compliance documentation
Manage the CVO operational budget with attention to revenue growth, margin improvement, cost-per-verification and operational efficiency
Identify opportunities to transform credentialing workflows through automation and technology adoption, including artificial intelligence; determine which processes are candidates for automation and which require manual oversight
Partner with Product Management and Engineering to prioritize platform capabilities based on operational impact and feasibility; Serve as a primary internal stakeholder for HealthStream's credentialing application
Define and track operational KPIs, dashboards, and reporting to measure CVO performance, identify quality issues or bottlenecks, and support capacity planning
Provide regular operational reporting to leadership with actionable insights
Collaborate with Sales leadership to support pipeline activity, provide operational feasibility input on prospective deals, and participate in client-facing conversations
Oversee the onboarding of new clients and maintains a relationship with existing clients.
Review, analyze and respond to client inquiries regarding compliance with NCQA, TJC and related accreditation standards
Manage client escalations and serve as the senior operational point of contact for complex or high-risk credentialing issues
Work with HealthStream Legal Department and Salesforce contacts to manage new and existing CVO services and products
You will be responsible for adhering to all HealthStream security policies, procedures, and assigned training.