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Vice President, Credentialing Operations

ID
2026-2154
Category
Credentialing
Position Type
Regular Full-Time
Min
USD $210,000.00/Yr.
Max
USD $220,000.00/Yr.

Overview

The Vice President of Credentialing Operations will be responsible for overseeing and managing all credentialing operations functions across the organization; this includes developing and implementing credentialing policies and procedures, ensuring compliance with federal and state regulations, and maintaining positive relationships with healthcare providers. Leads a team to verify provider credentials, onboard providers efficiently, and optimize the credentialing process.

Duties & Responsibilities

  • Oversee all credentialing operations and functions, ensuring timely and accurate primary source verification of credentials
  • Develop, implement, and optimize credentialing policies, procedures, and systems to maximize efficiency and maintain compliance
  • Lead and mentor a credentialing team, providing guidance and oversight to meet department goals and service level agreements
  • Serve as an expert and thought leader on credentialing regulations, trends, and best practices
  • Build and maintain positive relationships with providers and cross-functional teams
  • Manage credentialing budget and resources to meet organizational objectives
  • Ensure the accuracy and integrity of the provider database and directories
  • Identify opportunities for process improvement and implement changes to streamline credentialing

Skills Required

  • Bachelor's degree
  • 10 years of experience in healthcare credentialing, with at least 5 years in a leadership role
  • Expert knowledge of NCQA, CMS, federal, and state credentialing regulations and standards ·
  • Proven track record of developing and managing a high-performing credentialing team
  • Strong project management skills with the ability to lead process improvement initiatives
  • Excellent communication and relationship-building skills with both internal and external stakeholders
  • Proficiency in credentialing software and databases
  • Strong process improvement background in a BPO environment
  • Demonstrated ability to build, monitor, and execute on customer SLA’s to drive a seamless customer experience

 

 

Desired Skills and Qualifications:

  • Master’s degree
  • Experience with delegated credentialing models 
  • Lean Six Sigma or other process improvement certification
  • Active NAMSS, CPCS, or CPMSM certification
  • Experience credentialing providers in multiple states
  • Knowledge of provider enrollment and network management

Min

USD $210,000.00/Yr.

Max

USD $220,000.00/Yr.

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The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.


Applicants must be authorized to work in the U.S. on a full-time basis without the need for current or future sponsorship.


About symplr:

symplr is revolutionizing healthcare operations with a first-of-its-kind platform that drives effective, efficient, and connected workflows while increasing operational benefits and scaling clinical, financial, and quality outcomes—driving value where it matters most.


We are a remote-first company with employees working across the United States, India, and the Netherlands. Guided by values, we focus on teamwork, championing our customers, being rooted in action and outcomes, overcoming challenges, and leading through equality and integrity. Read more about symplr's culture and values at symplr.com/careers.


Perks & Benefits:

  • Company Sponsored Medical, Dental & Vision
  • Safe Harbor 401K with Employer Matching up to 5%, eligible upon hire with immediate vesting
  • HSA Employer Contributions, Employer Paid Life, Short-term and Long-term Disability, and AD&D Insurance Plans
  • Permissive Time Off Plans, Volunteer Time Off, & 12 Paid Holidays
  • Fully Paid Medical Leaves of Absence and Bonding Leaves for new parents
  • Tuition Assistance & Continuing Education Reimbursement available
  • Additional Employer-Paid Programs: Cleo Family Services, Care@Work Memberships, Headspace Memberships, LifeMart Discounts, and more!

symplr is an Equal Opportunity/Affirmative Action Employer. We consider applicants without regard to race, color, religion, age, national origin, ancestry, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, veteran status, disability, genetic information, citizenship status, or membership in any other group protected by federal, state or local law.


As an ongoing commitment to reasonably accommodate individuals with disabilities, symplr has established alternative methods to complete the application process. Disabled applicants needing assistance are encouraged to call 281.863.9500 if further assistance is required.


To all recruitment agencies: we do not accept resumes or partnership opportunities. Please do not forward resumes to symplr or any of our employees. We are not responsible for any fees related to unsolicited resumes.