Director – Credentialing Operations

Requirements

• 15+ years experience in the industry
• You understand the intricacies of compliance requirements across various accrediting bodies, payers, states & federal gov’t
• You’re customer-oriented, and a pro at navigating demanding customer relationships.
• You’re an empathetic & strong leader who inspires by example and cares about building a thriving team
• You understand the role of technology and how to leverage technology strategically in healthcare
• You have  a strong sense of urgency, responsibility, resourcefulness, and humility
• You are  comfortable leaning in and owning different parts of the business based on needs & timing
• You are a very strong critical thinker, is always using your full brain, and can just as easily zoom in as zoom out.

Client Relationship Management Responsibilities

• Build and maintain strong relationships with clients, ensuring their needs are met and addressing any concerns or issues.
• Work closely with other departments (e.g., Sales, R&D, CS, HR, Legal) to ensure seamless integration and alignment of operations.
• Support seamless and successful onboarding and launch of customers by supporting when needed during sales and implementation processes. Ensure the internal CVO team is prepared and ready for go-live.

Operational Excellence Responsibilities

• Oversee daily operations of our Credentialing Organization, particularly ensuring that we maintain and continuously improve our timeliness and quality.
• Monitor staff performance and work with CVO Team leads to address Performance Issues timely and proactively.
• Manage capacity strategically and nimbly; proactively forecast needs based on customer inputs and pipeline. Work with VP of Operations on capacity management, including forecasting, recruiting, hiring, and onboarding.
• Constantly maintain a focus on data and data-driven decision-making across the team.

Leadership and Team Management Responsibilities

• Lead, mentor and grow a team of Credentialing Specialists and Credentialing Team Leads, ensuring very high levels of performance and engagement.
• Foster a positive and collaborative work environment, promoting a team vs. individual mindset, positivity, and professional growth and development.
• As needed, take on different roles and projects based on the company’s need.

Compliance and Quality Assurance Responsibilities

• Ensure compliance with industry standards, regulations, and accreditation requirements (e.g., NCQA, URAC).
• Implement and maintain quality assurance programs to ensure the accuracy and integrity of credentialing processes.
• Conduct regular audits and reviews to identify areas for improvement and ensure compliance with best practices

Strategic Planning and Execution Responsibilities

• Collaborate with senior leadership to develop and execute the organization’s strategic plan.
• Identify opportunities for process improvements, cost reductions, and service enhancements.
• Lead initiatives to implement new technologies and systems that improve operational efficiency and effectiveness.