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