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About the Role

The Manager of Credentialing Operations oversees internal operational credentialing activities for the Health Plan, managing the end-to-end credentialing process for healthcare providers in compliance with regulatory, accreditation, and organizational standards. This role leads credentialing staff, ensures timely verification, enrollment, and maintenance of provider credentials, monitors performance, enforces quality standards, and drives process improvements.

Responsibilities

• Accomplishes defined objectives and oversees all activities which relate to provider credentialing through effective planning, organization and utilization of personnel and equipment.
• Develops and implements department goals and corresponding action plans and monitors performance against these goals.
• Manages the full lifecycle of provider credentialing and recredentialing processes, ensuring timely and accurate completion, and maintains compliance with federal, state, and accreditation standards (NCQA, CMS, etc.) as well as internal policies.
• Supervises, trains, and evaluates credentialing team members; provides coaching and support to drive productivity and quality.
• Provides direction and supervision for direct and indirect reports within the Credentialing team.
• Provides routine feedback on development, skills, and performance measurements.
• Identifies opportunities to increase efficiency, reduce turnaround times, and implement best practices and automation where possible.
• Participates in audits related to credentialing data and processes, ensuring documentation accuracy and audit readiness.
• Monitors performance metrics/KPIs, enforces quality standards, policies and procedures, and ensures accuracy and completeness of credentialing data.
• Establishes and maintains working relationships with internal departments to ensure credentialing operations are functioning and communicated appropriately.
• Addresses complex credentialing issues, provider data discrepancies, and escalations in a timely manner, including system issues.
• Manages relationships with credentialing vendors or CVOs (Credentialing Verification Organizations).
• Participates in budget/invoice reviews as needed.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
• Performs other duties and functions as assigned by management.

Requirements

• Minimum of three (3) years of credentialing, operations, or provider-related experience required.
• Minimum of five (5) years of progressive management experience with health care services and/or insurance, supported by a working knowledge of managed care principles and computer applications.
• Prior experience supervising or managing people and/or projects or indirectly leading teams.
• Strong project and personnel management skills and organizational skills essential.
• Experience in analyzing system data, developing and testing requirements, and working with system users.
• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Ability to work in a home office for continuous periods of time for business continuity.

Skills

• Managed care principles
• Computer applications

Location

• Remote work within all jobs posted by the Excellus Talent Acquisition team may be an opportunity, decided on a case-by-case basis.

Work Type

• Full-time

Experience Level

• Minimum of three (3) years of credentialing, operations, or provider-related experience
• Minimum of five (5) years of progressive management experience
• Prior experience supervising or managing people and/or projects or indirectly leading teams

Education Level

• Bachelor’s degree in Business Administration or health care field; in lieu of degree, a minimum of six (6) years of additional credentialing, operations, or provider-related experience required.

Salary/Compensations

• Grade E5: Minimum $71,880 - Maximum $129,384

Benefits

• Participation in group health and/or dental insurance
• Retirement plan
• Wellness program
• Paid time away from work
• Paid holidays

About the Company

• The Lifetime Healthcare Companies

Equal Opportunity

• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.