We are seeking a full-time, hybrid Credentialing Operations Manager that would be based out of our Tampa office. The Credentialing Operations Manager is responsible for overseeing and managing all aspects of the credentialing and recredentialing processes for clinicians and facilities. This role ensures that all providers and organizations meet regulatory and accreditation standards, and that all credentialing activities are executed efficiently, accurately, and in a timely manner. The Credentialing Operations Manager also leads delegation audits and partners with internal and external stakeholders to maintain the highest quality standards.

RESPONSIBILITIES:

Credentialing of Clinicians and Facilities:

• Oversee and manage the initial credentialing process for all clinicians (physicians, advanced practice providers, allied health professionals) and healthcare facilities.
• Ensure all applications and supporting documentation are collected, verified, and maintained according to organizational policies and regulatory requirements.
• Coordinate and communicate with providers, facilities, and internal teams to resolve discrepancies and expedite credentialing timelines.

Recredentialing Process:

• Lead and manage periodic recredentialing of clinicians and facilities in compliance with organizational, state, and federal guidelines.
• Monitor upcoming recredentialing deadlines and proactively communicate with providers and facilities to ensure timely completion.
• Analyze data and develop process improvements to streamline recredentialing activities and enhance compliance.

Delegation Audit Management:

• Develop and implement audit tools and protocols to assess delegated entities' compliance with credentialing standards.
• Conduct regular delegation audits, document findings, and report results to leadership and relevant stakeholders.
• Provide guidance and corrective action plans for delegated entities not meeting performance or compliance expectations.

Policy and Procedure Development:

• Maintain and update credentialing and recredentialing policies to reflect current regulations and best practices.
• Train and support credentialing staff on policies, procedures, and regulatory changes.

Compliance:

• Ensure all credentialing activities align with NCQA, URAC, The Joint Commission, and other relevant accreditation standards.
• Prepare for and participate in internal and external audits and surveys.

Stakeholder Communication:

• Act as a primary point of contact for credentialing inquiries from providers, facilities, internal departments, and regulatory agencies.
• Provide regular updates and reports on credentialing status, compliance metrics, and audit outcomes to senior leaders.

Key competencies:

• Leadership and team management
• Process improvement and project management
• Regulatory compliance and audit readiness
• Problem-solving and critical thinking
• Interpersonal and stakeholder relationship skills

SUPERVISORY RESPONSIBILITIES:

• Mentor, train, and supervise team members directly and indirectly, review their work and provide effective constructive feedback to achieve their best performance and goal attainment
• Set the tone for a strong Enterprise culture and high employee engagement.
• Ensure all team members understand, are trained in, and comply with Paradigm’s security requirements and policies.
• Ensure all team members have the minimum level of IT system access required to effectively complete their Paradigm responsibilities.

QUALIFICATIONS:

• Educational background: Bachelor’s degree in healthcare administration, business, or a related field (master’s preferred).
• Experience: Minimum of 3–5 years of experience in credentialing operations, with at least 2 years in a leadership or management role.
• Thorough understanding of credentialing requirements, accreditation standards, and regulatory guidelines (e.g., NCQA, URAC, CMS, The Joint Commission).
• Technical skills: proficiency in Microsoft Office suite (Excel, PowerPoint, Word), data visualization tools (e.g. Power BI).
• Analytical skills: strong ability to analyze complex data sets and derive actionable insights.
• Communication skills: exceptional written and verbal communication skills, with the ability to simplify complex topics for diverse audiences.
• Experience with credentialing software and data management systems.
• Collaboration: proven ability to work collaboratively with cross-functional teams in a fast-paced environment.
• Attention to detail: strong focus on accuracy and thoroughness in all deliverables.