What you will do

The Provider Credentialing & Licensing Lead will design, develop and oversee the onboarding and credentialing processes for healthcare providers within our network across 50 states and DC. This position requires a strong understanding of credentialing standards, attention to detail, and effective communication skills. This is an opportunity to build a best in class department.

Credentialing Process Management:

• Design and rollout the credentialing processes for healthcare providers, ensuring compliance with industry standards and regulatory requirements.
• Develop and implement efficient workflows to streamline the credentialing process.
• Manage the full licensure lifecycle for all providers, including tracking of upcoming expirations, timely renewals, and primary source verification of license status with state boards.
• Oversee collaborative practice and supervision agreements for advanced practice providers, including execution, renewal, and alignment with each state's requirements.

Quality Assurance:

• Implement quality assurance measures to ensure the accuracy and completeness of provider credentialing files.
• Conduct regular audits to identify and address any discrepancies or issues in the credentialing process.
• Run a recurring review of upcoming license and agreement expirations, coordinating timely action with internal teams so provider records remain current at all times.
• Maintain clear, documented procedures for core credentialing workflows, with cross-trained coverage for continuity.

Collaboration with Stakeholders:

• Work closely with internal departments, including network development, legal, and compliance, to ensure alignment in credentialing processes.
• Serve as a liaison between the credentialing team and healthcare providers, addressing inquiries and providing support.
• Provide regular status reporting to leadership and proactively raise any compliance risks or open items as they arise.

Data Management:

• Maintain accurate and up-to-date provider credentialing data in the credentialing database and ensure it stays in sync with downstream clinical systems.
• Generate reports and analytics related to provider credentialing for internal and external stakeholders.
• Facilitate licensure applications and renewals.
• Administer the credentialing platform and related tools (e.g., Medallion, CAQH, NPPES, state verification portals).

Who you are

• Bachelor's degree in healthcare administration, business, or a related field; Master's degree preferred.
• Minimum of 7+ years of experience in provider credentialing or a related role within the healthcare industry, ideally including multi-state telehealth experience.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) designation is highly desirable.
• Strong understanding of credentialing standards, regulations, and best practices, including state requirements for advanced practice provider supervision and collaborative practice.
• Hands-on experience with credentialing platforms and primary source verification tools.
• Excellent organizational and project management skills, with strong documentation habits.
• Effective communication and interpersonal skills, including comfort escalating issues to leadership early and clearly.