Offer summary

Qualifications:

Minimum 5 years of professional credentialing experience, particularly in primary care., Strong knowledge of Texas payers and Texas Medical Board requirements., Proficiency in credentialing software and advanced data management skills., Professional credentialing certification (CPCS, CPC, or similar) is preferred..

Key responsibilities:

Execute credentialing duties for up to 200 clinicians, including payer enrollment and data maintenance.

Serve as a mentor for credentialing specialists and support their onboarding and training.

Monitor workflow and productivity metrics to ensure optimal team performance.

Ensure compliance with NCQA, URAC, CMS, and state regulatory requirements across all credentialing activities.

Job description

Credentialing Lead

Department: Credentialing & Provider Operations
Reports To: Credentialing Manager / Director of Provider Operations

POSITION OVERVIEW

The Credentialing Lead serves as both a working subject matter expert and future team-level leader within Harbor Health's credentialing department. This dual role combines hands-on credentialing and enrollment work with emerging leadership responsibilities, including workflow optimization, process improvement, and team mentorship. The Credentialing Lead ensures compliance with regulatory and payer requirements while supporting the growth and maturation of credentialing functions across our payvider organization. This position is ideal for an experienced credentialing professional ready to take on expanded responsibilities in a dynamic healthcare startup environment.

POSITION DUTIES & RESPONSIBILITIES

Core Credentialing Functions

Execute all credentialing specialist duties including payer enrollment, provider credentialing, recredentialing, and data maintenance for up to 200 clinicians
Manage complex multi-state and multi-specialty credentialing requirements with accuracy and efficiency
Maintain current knowledge of Texas payers, Texas Medical Board (TMB) requirements, and evolving regulatory standards

Team Leadership & Support

Serve as primary resource and mentor for credentialing specialists, providing daily guidance and resolving escalated issues
Support onboarding and training of new credentialing team members
Participate in performance feedback processes and contribute to team development initiatives
Model solutions-oriented approach and professional excellence for the department

Process Management & Improvement

Monitor workflow execution, productivity metrics, and turnaround times to ensure optimal team performance
Identify operational gaps and opportunities for process standardization and improvement
Develop and maintain standard operating procedures, workflows, and training materials in collaboration with leadership
Lead or support system upgrades and transitions related to credentialing tools and data management

Compliance & Quality Assurance

Ensure adherence to NCQA, URAC, CMS, and state regulatory requirements across all credentialing activities
Support audit preparation and response activities, maintaining comprehensive documentation
Navigate transition from individual credentialing toward delegated status as the organization matures

Cross-Functional Collaboration

Partner with clinical operations, revenue cycle, compliance, and IT teams to align credentialing practices with organizational needs
Communicate effectively with internal stakeholders and external payers, regulatory bodies, and credentialing organizations
Support strategic planning and execution of credentialing initiatives that advance Harbor Health's payvider model

DESIRED PROFESSIONAL SKILLS & EXPERIENCE

Required Experience & Qualifications

Minimum 5 years of professional credentialing experience, with primary care credentialing experience required
Demonstrated ability to manage medical staff profiles for up to 200 clinicians
Experience with individual credentialing processes and familiarity with delegated credentialing concepts
Strong knowledge of Texas payers and Texas Medical Board requirements
Multi-specialty credentialing experience preferred

Technical Competencies

Proficiency in credentialing software, EMR systems, CAQH ProView, and various payer portals
Advanced data management and documentation skills
Experience with credentialing databases and workflow management systems

Leadership & Soft Skills

Proven mentorship and team support capabilities with strong interpersonal skills
Excellent project management abilities with capacity to manage concurrent initiatives and deadlines
Solutions-oriented mindset with demonstrated process improvement experience
Clear communication skills for cross-functional collaboration and stakeholder management

Regulatory Knowledge

Deep understanding of NCQA, CMS, and state credentialing regulations
Current knowledge of healthcare compliance requirements and audit processes
Familiarity with payvider operational models and credentialing implications

Preferred Qualifications

Professional credentialing certification (CPCS, CPC, or similar)
Experience in healthcare startup or rapidly growing organization environments
Background supporting organizational transitions from individual to delegated credentialing status

WHAT WE OFFER

Opportunity to shape the credentialing function within a growing payvider organization and directly impact member care delivery
Collaborative and dynamic work environment
An organization made of people who are passionate about changing the healthcare landscape
Competitive salary and benefits package
Professional development and growth opportunities including potential advancement to formal leadership roles
A transparent and unique culture

Required profile