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General Summary

Provides day-to-day oversight, quality assurance, and guidance to Credentialing Coordinators. Ensures accuracy, timeliness, and compliance of credentialing, recredentialing, and enrollment activities in accordance with NCQA, CMS, and organizational standards. Develops and maintains Standard Operating Procedures (SOPs), coordinates staff training, performs QA audits, and serves as a subject matter expert and escalation point for complex issues.

Duties and Responsibilities

Remote Work Capable

Essential Functions:

+ Leadership and Oversight - Monitors workload distribution and assists leadership with level-loading and performance tracking. - Serves as the primary escalation point for questions, process clarification, and problem resolution. - Conducts quality assurance reviews on applications, verifications, and payor submissions to identify errors, trends, and training needs. - Prepares and reports QA findings and metrics to management with recommendations for improvement.

+ Training and Development - Develops and maintains training materials, job aids, and reference guides. - Provides onboarding and ongoing training for new and existing staff. - Conducts competency assessments to ensure adherence to standards and continuous improvement. - Facilitates cross-training within the team to promote operational flexibility.

+ Policy, Process and SOP Management - Authors updates and maintains Standard Operating Procedures (SOPs) and Work Instructions in collaboration with leadership. - Ensures all procedures remain current and compliant with accreditation and regulatory requirements. - Partners with leadership to evaluate and improve workflow efficiency, automation and documentation practices. - Acts as liaison with IT, Population Health and other internal teams to communicate system or policy updates impacting credentialing and enrollment processes.

+ Quality Assurance and Reporting - Performs routine audits on credentialing and payor enrollment files to ensure compliance and accuracy. - Tracks audit outcomes, trends and corrective actions. - Provides regular QA and productivity reports to the Director and Manager. - Supports internal and external audits (NCQA, CMS, payer, or internal compliance).

+ Collaboration and Continuous Improvement - Works closely with management to identify system, process and training opportunities. - Participates in strategic discussions to improve departmental efficiency, data integrity and customer service. - Supports and models WellSpan's core values of integrity, teamwork and accountability.

Qualifications

Minimum Education:

+ High School Diploma or GED Required

+ Associates Degree in Business, Health Administration, or related field Preferred

Work Experience:

+ 5 years credentialing or payor enrollment experience Required

+ 2 years demonstrated leadership, training, or QA experience Preferred

Licenses:

+ Certified Provider Credentialing Specialist Upon Hire Preferred or

+ Certified Professional Medical Services Management Upon Hire Preferred

Knowledge, Skills, and Abilities:

+ Strong organizational, leadership, and communication skills

+ Proven ability to train and mentor others

+ Excellent attention to detail and accuracy

+ Skilled in analyzing data, identifying root causes, and implementing corrective action

+ Strong working knowledge of credentialing systems (Cactus, or equivalent)

+ Demonstrated ability to write SOPs and manage version control

Benefits Offered:

Comprehensive health benefits

Flexible spending and health savings accounts

Retirement savings plan

Paid time off (PTO)

Short-term disability

Education assistance

Financial education and support, including DailyPay

Wellness and Wellbeing programs

Caregiver support via Wellthy

Childcare referral service via Wellthy

Quality of Life

Founded in 1741, the city of York is considered by many as the first capital of the United States. The Articles of Confederation were signed by the Second Continental Congress here in 1777. Its beautifully restored historic district is an architectural treasure. While York retains its farming and manufacturing heritage, at its heart York is a thriving cultural community that has attracted creative talent and innovative entrepreneurial investors from across the nation.

Life in York County offers affordable housing, options for higher education, a thriving arts and cultural community, historical attractions, parks and recreational resources, semi-professional baseball team, fine dining and more - within an easy drive of major East Coast cities.

York County residents can find local employment in healthcare, manufacturing, technology, agricultural and service sectors. (Patient population: 445,000)

WellSpan Health is an Equal Opportunity Employer. It is the policy and intention of the System to maintain consistent and equal treatment toward applicants and employees of all job classifications without regard to age, sex, race, color, religion, sexual orientation, gender identity, transgender status, national origin, ancestry, veteran status, disability, or any other legally protected characteristic.