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Director, Credentialing Operations

Remote: 
Full Remote
Experience: 
Expert & Leadership (>10 years)
Work from: 
United States

Offer summary

Qualifications:

15+ years experience in healthcare industry, Strong understanding of compliance requirements, Proven leadership and team management skills, Experience leveraging technology in operations.

Key responsabilities:

  • Build and maintain client relationships
  • Oversee daily operations of credentialing organization
Verifiable logo
Verifiable SME https://www.verifiable.com/
51 - 200 Employees
About Verifiable
Verifiable is an API-first, provider network management platform built to help healthcare provider and payer organizations speed up network operations, save costs and streamline the provider experience. Verifiable industry-leading provider data infrastructure connects to thousands of primary sources to deliver real-time provider verification & monitoring to automate the credentialing process - resulting 78% faster turnaround times and millions in added revenue capture. Verifiable works with innovative healthcare provider and payer organizations like Humana, Lyra Health, Talkspace, Modern Health, Wheel, Grow Therapy, and many others. Verifiable is a proud Y-Combinator company whose investors include Craft Ventures, Highland Capital Partners, Tiger Global, The Altman Fund, Struck Capital, Liquid2 Ventures, 137 Ventures, Cooley and Soma Capital.
See more Verifiable offers

Job description

About You:

Our credentialing team is core to our business and is responsible for helping our clients credential their providers so patients can receive care safely and as soon as possible. We're looking for a strong operator and seasoned healthcare/credentialing leader who has experience managing large-scale credentialing operations to help with client relationship management, strategic planning, operational management and team leadership.

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.

    • Required profile

    Experience

    Level of experience: Expert & Leadership (>10 years)
    Spoken language(s):
    English
    Check out the description to know which languages are mandatory.

    Hard Skills

    Customer Relationship ManagementOperations ManagementCredential ManagerCompliance ManagementResource UtilizationPerformance ManagementData-Driven Decision Making

    Other Skills

    • Problem Solving
    • Communication
    • Resourcefulness
    • Teamwork
    • Critical Thinking
    • Empathy
    Are you interested?

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