Credentialing Lead

Summary

Join Harbor Health's credentialing department as a Credentialing Lead, a dual role combining hands-on credentialing and enrollment work with leadership responsibilities. You will execute all credentialing specialist duties, manage complex credentialing requirements, and maintain current knowledge of regulations. As a mentor, you will guide credentialing specialists, support onboarding, and participate in performance feedback. You will also monitor workflow, identify process improvements, and develop standard operating procedures. Ensure compliance with NCQA, URAC, CMS, and state requirements, and collaborate with cross-functional teams. This position is ideal for an experienced credentialing professional ready for expanded responsibilities in a dynamic healthcare startup.

Requirements

• 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
• 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
• 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
• 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

Responsibilities

• 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
• 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
• 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
• 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
• 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

Preferred Qualifications

• Multi-specialty credentialing experience preferred
• 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

Benefits

• Competitive salary and benefits package
• Professional development and growth opportunities including potential advancement to formal leadership roles
• A transparent and unique culture