Credentialing Team Lead @ Certify

Operations & Logistics (2)
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Operations & Logistics (2)

ABOUT CERTIFY:

We are on a mission to change how the US healthcare industry deals with provider data. Our goal is to reduce the cost of healthcare by streamlining access to provider data and reducing administrative and regulatory burden on healthcare organizations.

Certify is revolutionizing the healthcare industry by laying the infrastructure upon which the next generation of provider-centric applications (network adequacy, accuracy, provider utilization, etc.) will be built. As innovative digital health plans and provider care models continue to scale and challenge traditional care models, the need for a centralized data infrastructure has never been greater. Our platform will support the future of healthcare innovation by becoming the source of truth of provider data and making that data easily accessible and actionable for the entire healthcare ecosystem.

We have built an API-first, UI-agnostic, end-to-end provider network management platform automating licensing, enrollment, credentialing, and network monitoring. With direct integrations into 100’s of primary sources, we are uniquely positioned to enhance visibility into the entire provider network management process. Our team has more than 25+ years of combined experience building provider data systems at Oscar Health and are backed by top-tier VC firms who share our vision of creating a one-of-a-kind healthcare cloud that removes the friction surrounding provider data.

At Certify, we pride ourselves on fostering a meritocratic environment that ensures every voice has an opportunity to be heard. Founded on the principles of trust, transparency, and accountability, we aim to challenge the status quo at every step and are looking for purpose-driven team members to share our journey in redefining the Healthcare data infrastructure.

ABOUT THE ROLE:

As Certify scales, we need to add rigor & structure to our operational processes to continue driving high customer satisfaction at increasingly attractive unit economics. We’re looking to hire an Operations Team Lead to lead a critical pod of our Credentialing team – someone who combines best-in-class people leadership with strong ownership and a relentless focus on speed & quality. This individual will oversee a production-focused pod made up of operations analysts (OAs).

The Credentialing, Team Lead will oversee day-to-day credentialing operations, ensuring compliance with regulatory requirements and internal quality standards. This role requires strong leadership, direct client engagement, and prior stakeholder management experience.. The Team Lead will act as a subject matter expert, guiding the team in meeting performance, quality, and compliance expectations. This is a fully remote role with working hours aligned to EST time zones.

What You'll Do

People Management & Team Leadership:
Lead and manage a team of Credentialing Specialists and Operational Analysts to ensure timely and accurate credentialing file processing.
Provide coaching, mentoring, and training to team members to strengthen credentialing knowledge and regulatory understanding.
Oversee credentialing workflows to ensure compliance with NCQA guidelines, state regulatory requirements, and client-specific policies.
Facilitate company performance reviews, and partner with Operations Management to determine performance ratings for the OAs on your team and deliver performance review conversations directly to your team members.
You will host a daily standup with your team as needed to review the previous day’s performance and align on priorities for the day ahead. Additionally, you will lead a weekly performance review to recap results from the prior week and identify opportunities for improvement.
Other focus areas will include supporting the onboarding of new hires, providing education and guidance to team members during training, and eventually participating in the hiring process for new OAs joining your team.
Regularly review your team’s performance data on a daily and weekly basis, and communicate insights upward to management, downward to your team, and laterally to your peers to ensure alignment and accountability across all levels.

Production Management:
This role is responsible for meeting core performance metrics for the subset of clients supported by your pod. These metrics focus on the speed, quality, and efficiency of file processing. You will be expected to continuously identify and drive improvements in each of these areas as volumes scale.
Monitor the contractual Service Level Agreement, turnaround times, and quality metrics; drive corrective actions to maintain compliance and efficiency.
Partner with internal stakeholders to resolve escalations, streamline workflows, and improve operational outcomes.
Oversee the monthly ongoing monitoring and management of credentialing expirables.
Maintain proactive communication with OAs to ensure they remain unblocked and productive. In addition, coordinate with Credentialing Management to identify the highest-priority files and ensure your team is fully equipped to process them.
Identify process gaps and implement documented improvements.
Facilitate team training sessions as needed to strengthen skills and ensure process consistency.
Demonstrated ability to create comprehensive SOPs and develop ad hoc reports to support operational needs.

What You'll Need

Minimum of 5+ years of overall professional experience, with at least 2 years in a team management role.
Demonstrated ability to lead and manage a team of 5 or more members.
Proven experience working effectively with cross-functional teams.
Strong exposure to collaborating with global teams and stakeholders.
Demonstrated success in client engagement and managing client relationships.
A passion for driving continuous improvement in metrics week over week, coupled with a desire to dive deep into processes to understand how they function and how they connect to key company outcomes.
Ability to be hands-on and execution-focused in the short term while also thinking strategically to drive long-term success.
Serve as the primary point of contact for client engagement, including participating in client meetings, addressing escalations, and ensuring client satisfaction.
Proven excellence in organization and attention to detail.
Proven ability to manage multiple initiatives simultaneously with a clear track record of prioritizing the most critical objectives.
Strong organizational, analytical, and problem-solving skills.
Excellent written and verbal communication skills.
Proven ability to effectively manage in a production environment while overseeing and driving daily performance metrics.

Nice to Have:

Minimum 1–2 years of experience in credentialing, provider enrollment, or healthcare setting and compliance.
Strong knowledge of NCQA guidelines and state/federal regulatory requirements related to credentialing.
Proficient in SQL, Excel Macros, and related data analysis tools.

At Certify, we're committed to creating an inclusive workplace where everyone feels valued and supported. As an equal opportunity employer, we celebrate diversity and warmly invite applicants from all backgrounds to join our vibrant community.

Credentialing Team Lead

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