Credentialing Operations Lead
Talkiatry
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $60,000 - $62,000 per year
Job Level
Senior
About the role
- Supervise Credentialing Specialists’ execution of daily credentialing tasks, ensuring workflows and file progression align with defined SLAs and onboarding timelines.
- Serve as a subject matter expert on credentialing workflows, helping ensure accuracy, consistency, and adherence to SOPs across the team.
- Act as the first point of triage for provider delays, documentation gaps, or platform blockers, escalating issues to the Credentialing Manager with relevant context and proposed resolution paths.
- Monitor the PSV inbox and Booking Calendar daily to ensure accurate scheduling and appropriate specialist coverage; troubleshoot provider mis bookings and act as backup when needed.
- Maintain accurate records in internal trackers and credentialing platforms, including applying start date changes, updating license information, and triggering appropriate workflows for new start dates, and recredentialing events.
- Execute the Certificate of Insurance (COI) process for new providers, additional licenses, and terminations, including internal coordination and documentation.
- Process credentialing and recredentialing files as needed, particularly during volume spikes or to cover for out-of-office specialists.
- Track provider onboarding progress daily using internal trackers and dashboards, and flag risks, blockers, or process deviations to Credentialing leadership in a timely and structured manner.
- Conduct quality review of all credentialing files to ensure alignment with documentation standards, audit readiness, and committee requirements.
- Identify recurring workflow or documentation issues and escalate process gaps, training needs, or performance concerns to the Credentialing Manager.
- Maintain and update operational SOPs, reference materials, and training content in collaboration with department leadership.
- Provide day-to-day guidance and workflow support to Credentialing Specialists, helping troubleshoot execution issues and reinforcing adherence to SOPs and documentation standards.
- Deliver workflow-based training and refreshers to Credentialing Specialists and support onboarding of new team members.
- Execute monthly compliance monitoring activities, including NPDB re-enrollments, exclusion list checks (e.g., OIG, SAM), and certification audits.
- Assist with preparing for quarterly delegated payor audits by compiling required documentation, reviewing credentialing packets to submit, and helping ensure audit readiness.
- Collaborate with cross-functional partners (e.g., Compliance, HR, ClinOps, Payer Relations, Clinical) to collect and validate credentialing materials as needed by payors.
- Track and maintain organized documentation logs for audit submissions, committee approvals, and supporting materials.
- Assist in submitting audit materials and updating rosters and other audit-related reporting.
Requirements
- 3+ years of experience in healthcare credentialing, with a strong understanding of end-to-end workflows.
- Strong working knowledge of NCQA standards and documentation expectations.
- Ability to interpret and apply accreditation standards, regulatory requirements, and internal credentialing policies.
- Demonstrated ability to execute high-volume credentialing processes with precision and attention to detail.
- Experience supporting peers through workflow guidance, training sessions, and quality assurance efforts in a high-volume, SLA-driven environment.
- Experience with credentialing platforms (e.g., Medallion, Verifiable) and multi-state provider onboarding processes.
- Excellent organizational skills and attention to detail, with the ability to manage multiple workstreams concurrently.
- Strong interpersonal and communication skills, with the ability to coach peers.
- Polished verbal and written communication skills, with the professionalism required to engage with clinical leaders and represent credentialing in committee settings.
- Comfort operating in a fast-paced, execution-focused environment where priorities may shift frequently.
- Bachelor’s degree preferred.
Benefits
- medical, dental, vision, effective day 1 of employment
- 401K with match
- generous PTO plus paid holidays
- paid parental leave
- and more!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
credentialingquality reviewcompliance monitoringaccreditation standardshigh-volume credentialing processesdocumentation standardsworkflow guidancetrainingaudit readinessprovider onboarding
Soft skills
organizational skillsattention to detailinterpersonal skillscommunication skillscoachingproblem-solvingteam supportadaptabilityleadershipcollaboration