Vice President, Credentialing Operations

symplr

25d • $210,000 - $220,000

About The Position

The Vice President of Credentialing Operations will be responsible for overseeing and managing all credentialing operations functions across the organization; this includes developing and implementing credentialing policies and procedures, ensuring compliance with federal and state regulations, and maintaining positive relationships with healthcare providers. Leads a team to verify provider credentials, onboard providers efficiently, and optimize the credentialing process.

Requirements

• Bachelor's degree
• 10 years of experience in healthcare credentialing, with at least 5 years in a leadership role
• Expert knowledge of NCQA, CMS, federal, and state credentialing regulations and standards
• Proven track record of developing and managing a high-performing credentialing team
• Strong project management skills with the ability to lead process improvement initiatives
• Excellent communication and relationship-building skills with both internal and external stakeholders
• Proficiency in credentialing software and databases
• Strong process improvement background in a BPO environment
• Demonstrated ability to build, monitor, and execute on customer SLA’s to drive a seamless customer experience

Nice To Haves

• Master’s degree
• Experience with delegated credentialing models
• Lean Six Sigma or other process improvement certification
• Active NAMSS, CPCS, or CPMSM certification
• Experience credentialing providers in multiple states
• Knowledge of provider enrollment and network management

Responsibilities

• Oversee all credentialing operations and functions, ensuring timely and accurate primary source verification of credentials
• Develop, implement, and optimize credentialing policies, procedures, and systems to maximize efficiency and maintain compliance
• Lead and mentor a credentialing team, providing guidance and oversight to meet department goals and service level agreements
• Serve as an expert and thought leader on credentialing regulations, trends, and best practices
• Build and maintain positive relationships with providers and cross-functional teams
• Manage credentialing budget and resources to meet organizational objectives
• Ensure the accuracy and integrity of the provider database and directories
• Identify opportunities for process improvement and implement changes to streamline credentialing

What This Job Offers

• Job Type: Full-time
• Career Level: Executive