HR Generalist
Elevate Eyecare
Credentialing Operations Manager
Hazel
full-time
Posted on:
Origin: • 🇺🇸 United States • Alabama, Arizona, California, Colorado
Visit company websiteSalary
💰 $90,000 - $105,000 per year
Job Level
SeniorLead
About the role
- Lead, mentor, and manage a team of Credentialing Specialists; oversee daily operations and performance evaluations.
- Oversee all aspects of credentialing, re-credentialing, and provider enrollment processes.
- Develop, implement, and maintain credentialing policies and procedures aligned with industry standards (The Joint Commission, NCQA, state and federal regulations).
- Serve as primary point of contact for internal and external audits; ensure files and processes are audit-ready and compliant.
- Continuously evaluate and improve credentialing workflows, manage credentialing database/software to ensure data integrity.
- Act as subject matter expert on credentialing matters; resolve complex issues and advise senior leadership on compliance risks and provider network management.
- Build and maintain relationships with internal departments (People/HR, Legal & Compliance, Clinical Operations) and external stakeholders (insurance payers, licensing boards).
- Prepare and present regular reports on departmental metrics including processing times, compliance rates, and team productivity.
Requirements
- Bachelor's degree in Healthcare Administration, Business, or a related field.
- A minimum of 7 years of progressive experience in credentialing, with at least 3 years in a supervisory or management role.
- Expert knowledge of primary care and behavioral health credentialing standards and regulatory requirements (e.g., CMS, state licensing boards, NCQA).
- Proven leadership skills with experience hiring, training, and developing a team.
- Exceptional organizational skills and an analytical mindset with high attention to detail.
- High level of proficiency with Microsoft Office Suite (Word, Excel, Outlook) and experience with HRIS or credentialing software
- Strong communication and interpersonal skills, capable of working effectively with professionals at all levels.
- Preferred: Master's degree in a relevant field.
- Preferred: Professional certification such as Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).
- Preferred: Extensive experience with credentialing software (e.g., Modio, Athena, Salesforce) and database management.
- Preferred: Experience leading a department through a major audit or accreditation survey.
