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CertifyOS · 1 month ago

Credentialing - Team Lead

United States

Full-time

Remote

Senior Level

$70K/yr - $100K/yr

5+ years exp

CertifyOS is on a mission to transform the US healthcare industry by streamlining access to provider data. The Credentialing Team Lead will oversee day-to-day credentialing operations, ensuring compliance with regulatory requirements and internal quality standards while leading a team of Credentialing Specialists and Operational Analysts.

Developer APIsHealth CareSoftware

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, and partner with Operations Management to determine performance ratings for the OAs on your team and deliver performance review conversations directly to your team members

You will host a daily standup with your team as needed to review the previous day’s performance and align on priorities for the day ahead. Additionally, you will lead a weekly performance review to recap results from the prior week and identify opportunities for improvement

Other focus areas will include supporting the onboarding of new hires, providing education and guidance to team members during training, and eventually participating in the hiring process for new OAs joining your team

Regularly review your team’s performance data on a daily and weekly basis, and communicate insights upward to management, downward to your team, and laterally to your peers to ensure alignment and accountability across all levels

This role is responsible for meeting core performance metrics for the subset of clients supported by your pod. These metrics focus on the speed, quality, and efficiency of file processing. You will be expected to continuously identify and drive improvements in each of these areas as volumes scale

Monitor the contractual Service Level Agreement, turnaround times, and quality metrics; drive corrective actions to maintain compliance and efficiency

Partner with internal stakeholders to resolve escalations, streamline workflows, and improve operational outcomes

Oversee the monthly ongoing monitoring and management of credentialing expirables

Maintain proactive communication with OAs to ensure they remain unblocked and productive. In addition, coordinate with Credentialing Management to identify the highest-priority files and ensure your team is fully equipped to process them

Identify process gaps and implement documented improvements

Facilitate team training sessions as needed to strengthen skills and ensure process consistency

Demonstrated ability to create comprehensive SOPs and develop ad hoc reports to support operational needs

Qualification

Client EngagementCredentialing KnowledgeRegulatory ComplianceTeam ManagementData AnalysisSQLExcel MacrosProblem-SolvingCommunication SkillsOrganizational Skills

Required

Minimum of 5+ years of overall professional experience, with at least 2 years in a team management role

Demonstrated ability to lead and manage a team of 5 or more members

Proven experience working effectively with cross-functional teams

Strong exposure to collaborating with global teams and stakeholders

Demonstrated success in client engagement and managing client relationships

A passion for driving continuous improvement in metrics week over week, coupled with a desire to dive deep into processes to understand how they function and how they connect to key company outcomes

Ability to be hands-on and execution-focused in the short term while also thinking strategically to drive long-term success

Serve as the primary point of contact for client engagement, including participating in client meetings, addressing escalations, and ensuring client satisfaction

Proven excellence in organization and attention to detail

Proven ability to manage multiple initiatives simultaneously with a clear track record of prioritizing the most critical objectives

Strong organizational, analytical, and problem-solving skills

Excellent written and verbal communication skills

Proven ability to effectively manage in a production environment while overseeing and driving daily performance metrics

Preferred

Minimum 2-3 years of experience in credentialing, provider enrollment, or healthcare setting and compliance

Strong knowledge of NCQA guidelines and state/federal regulatory requirements related to credentialing

Proficient in SQL, Excel Macros, and related data analysis tools

Company

CertifyOS

CertifyOS is architecting the modern provider data infrastructure — combining best-in-class technology, best-in-class data, and deep domain expertise to transform how healthcare operates.

Founded in 2021

New York, New York, USA

201-500 employees