Senior Manager, Credentialing Operations

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The Senior Manager, Credentialing Operations is the leader of critical functions within the Credentialing Verification Organisation (CVO) and is accountable for the delivery of credentialing services, including production, quality, reporting, ongoing monitoring, and continuous process improvement.

This role ensures the accuracy, integrity, and compliance of provider credentialing data across multiple lines of business, supporting the development and maintenance of a high-quality provider network.

Key Responsibilities

• Leads a business services unit that delivers credentialing services in support of organisational objectives.
• Establishes and communicates strategic direction for Credentialing Operations and ensures processes align with enterprise goals and priorities.
• Analyses operational performance metrics and key initiatives to evaluate progress against business objectives and identify opportunities for improvement.
• Develops and implements strategies that enhance operational effectiveness, quality, compliance, and service delivery.
• Serves as a trusted advisor to internal and external stakeholders on credentialing operations, business reviews, and related initiatives.
• Leads audit activities, including issue identification, corrective action planning, error remediation, and rebuttal management.
• Reviews audit findings for accuracy and provides guidance on issues with significant business or regulatory implications.
• Partners with Network Management, Provider Relations, Provider Services, Health Delivery teams, and other cross-functional stakeholders to address provider-related issues and improve operational outcomes.
• Drives continuous improvement initiatives that streamline processes, reduce risk, and enhance the provider and customer experience.
• Fosters a culture of accountability, collaboration, innovation, and high performance.

Required Qualifications

• Minimum of 5 years of experience in provider data management, provider network operations, provider relations, credentialing, or a related healthcare operations function.
• Minimum of 3 years of experience leading and developing teams.
• Experience working in credentialing operations.
• Knowledge of and experience supporting Medicare, Medicaid, and/or Commercial Health Insurance lines of business.
• Strong analytical, problem-solving, and decision-making skills.
• Demonstrated ability to influence stakeholders and drive results across cross-functional teams.
• Strong written and verbal communication skills.

Preferred Qualifications

• Experience leading operational transformation or continuous improvement initiatives.
• Experience working within a Credentialing Verification Organisation (CVO) environment.
• Experience utilising data and metrics to drive operational performance and business decisions.
• Proven ability to manage multiple priorities in a fast-paced, highly regulated environment.

Education

• Bachelor's degree or equivalent work experience

Pay Range

The typical pay range for this role is: $82,940.00 - $182,549.00

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.