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The Credentialing Assistant Manager is responsible for overseeing the credentialing process for healthcare professionals within an organization. They work closely with the Credentialing Manager leading a team to administer all credentialing processes and services, this includes verifying education, employment history, and professional references, as well as conducting background checks and ensuring compliance with regulatory requirements. The Credentialing Assistant Manager also assists in managing the credentialing database, maintaining accurate records, and coordinating with internal departments and external agencies to facilitate the credentialing process. They are responsible for ensuring the credentialing and compliance processes for network providers is efficient, operationally sound, and proactively in line with applicable State and Federal laws and regulations, as well as National Committee for Quality Assurance (NCQA) standards.

Functional Competencies:

• Maintain a comprehensive understanding of healthcare credentialing requirements
• Assist in leading a top-tier, metrics-driven credentialing operation maintaining compliant operations while achieving best-in-class turnaround times
• Provide leadership, mentoring, training, and coaching to all Credentialing team members
• Serve as a point of contact for internal and external clients as it relates to credentialing requirements, and credentialing needs
• Facilitate completion of department goals and continuously monitor process improvement initiatives
• Coordinate audits of Credentialing documents/processes
• Implements performance management strategies as needed to optimize team member contributions
• Facilitate Credentialing Committee and governance
• Actively participate in the maintenance of the provider database(s) by receiving and communicating changes to appropriate parties and performing the changes within the system when necessary.
• Routinely monitors database(s) to assure accuracy (report changes to the appropriate data entry sources)
• Assist in Leading our delegated credentialing program, including program development, monitoring, and audits.
• Establish collaborative working relationships that support cross-functional relationships and accomplishments

Behavioral Competencies:

• Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.
• Initiative: readiness to lead or take action to achieve goals.
• Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
• Member-focused: going above and beyond to make our members feel seen, valued and appreciated.
• Detail oriented and thorough: managing and completing details of assignments without too much oversight.
• Flexible and responsive: managing new demands, changes, and situations.
• Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.
• Integrity & responsibility: acting with a clear sense ownership for actions, decisions and to keep information confidential when required.
• Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.

Minimum Qualifications:

• Associate’s degree in business or health care related field or equivalent military or industry experience
• 3-5 years of experience in supervisory or management level experience in credentialing 
• Demonstratable knowledge of NCQA standards
• Demonstratable knowledge of payer credentialing standards
• Must have CPCS Certification or earn within 120 days of hire
• Excellent interpersonal, oral, and written communication skills required
• 3-5 years of experience with MS Office and be comfortable operating with multiple open screens and systems simultaneously
• 3-5 years of experience in vision, dental or medical related field
• Demonstratable critical thinking, organizational skills required
• Must be detail oriented and with high accuracy rate providing superior products and customer service
• Must be able to work independently
• Ability to form collaborative relationships tha