Credentialing Specialist
Blank StreetSalary not specified
Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
- Strong leadership and people management skills
- Subject matter expertise in credentialing processes
- Hands-on expertise in credentialing operations
- Knowledge of NCQA guidelines, state regulatory requirements, and client-specific policies
- Experience with compliance and quality standards in credentialing
- Ability to engage directly with clients
- Relentless focus on speed, quality, and performance metrics
Responsibilities
- 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, partner with Operations Management to determine performance ratings for OAs, and deliver performance review conversations to team members
- Host daily standups to review previous day’s performance and align on priorities
- Lead weekly performance reviews to recap results and identify improvement opportunities
- Support onboarding of new hires and provide education/guidance during training
- Participate in the hiring process for new OAs
- Regularly review team’s performance data on a daily and weekly basis
- Oversee day-to-day credentialing operations, ensuring compliance with regulatory requirements and internal quality standards
- Act as a subject matter expert, guiding the team in meeting performance, quality, and compliance expectations
Skills
Credentialing
Provider Enrollment
Licensing Verification
Network Monitoring
Team Leadership
Healthcare Operations
Process Optimization
Customer Satisfaction
Provider Data Management
Regulatory Compliance
CertifID
Prevents wire fraud in real estate transactions
About CertifID
CertifID focuses on preventing wire fraud in real estate transactions by providing a digital platform that ensures secure fund transfers. The platform validates the identities of all parties involved in a transaction and securely shares wiring information, which helps reduce the risk of fraud and streamline operations for real estate professionals. Unlike its competitors, CertifID emphasizes user-friendliness and integration into existing workflows, allowing clients to regain confidence in their transactions. The company's goal is to protect all parties in real estate deals from wire fraud, ensuring that their funds are safe and secure.
Grand Rapids, MichiganHeadquarters
2017Year Founded
$32.6MTotal Funding
SERIES_BCompany Stage
Fintech, Real EstateIndustries
51-200Employees