Provider Operations Manager – Credentialing

Job not on LinkedIn

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $73k - $115k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Support day-to-day credentialing operations, including working queues, unblocking complex cases, and driving turnaround times and quality. • Capture operational knowledge in clear SOPs and maintain a current central documentation library. • Help manage and develop the offshore team through training, documentation, and quality and productivity monitoring. • Partner on offshore transitions by identifying transferable work and supporting smooth handoffs. • Assess operational pain points, use data to size opportunities, and build business cases for AI, technology, and offshore solutions. • Create and implement AI solutions to improve operational efficiency and scale, partnering with product and engineering as needed. • Support the 2027 CVO vendor transition, including workflow mapping, requirements, testing, cutover, and vendor performance monitoring. • Become an expert in internal systems and tools, troubleshoot issues, and propose improvements to system logic. • Own operational metrics, build reporting, surface trends and bottlenecks, and guide decisions with data. • Ensure credentialing operations comply with CMS, AAAHC, and state requirements. • Partner with internal leadership, network and contracting teams, providers, vendors, and offshore partners.

🎯 Requirements

• 3-5+ years in operations, process improvement, or consulting. • A true operator with a bias toward action; willing to roll up your sleeves and do the work, not just direct it. • Passion for efficiency and ability to predict and prevent bottlenecks. • Comfortable moving between big-picture strategy and detailed execution. • Ability to shift focus and reprioritize quickly in a fast-paced, evolving environment. • Stamina for complex and difficult problems. • Detail-oriented, with a high bar for quality and accuracy. • Ability and desire to understand and follow complex regulations. • Strong communication and ability to work with cross-functional stakeholders and drive alignment. • Data, systems, and tech savvy, with ability to build reporting that improves decision-making. • Healthcare experience. • Familiarity with credentialing standards and CMS requirements. • Hands-on experience building and deploying AI tools to improve workflows, or strong track record applying technology and automation to operational problems. • Experience with process improvement methodologies.

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • Commission eligibility for Sales roles • Parental leave program • 401K program