Credentialing Team Lead
Posted on September 08, 2025 (about 6 hours ago)
About Certify
We are on a mission to change how the US healthcare industry deals with provider data. Our goal is to reduce the cost of healthcare by streamlining access to provider data and reducing administrative and regulatory burden on healthcare organizations.
Certify is revolutionizing the healthcare industry by laying the infrastructure upon which the next generation of provider-centric applications (network adequacy, accuracy, provider utilization, etc.) will be built. As innovative digital health plans and provider care models continue to scale and challenge traditional care models, the need for a centralized data infrastructure has never been greater. Our platform will support the future of healthcare innovation by becoming the source of truth of provider data and making that data easily accessible and actionable for the entire healthcare ecosystem.
We have built an API-first, UI-agnostic, end-to-end provider network management platform automating licensing, enrollment, credentialing, and network monitoring. With direct integrations into hundreds of primary sources, we are uniquely positioned to enhance visibility into the entire provider network management process. Our team has more than 25 years of combined experience building provider data systems at Oscar Health and are backed by top-tier VC firms who share our vision of creating a one-of-a-kind healthcare cloud that removes the friction surrounding provider data.
At Certify, we pride ourselves on fostering a meritocratic environment that ensures every voice has an opportunity to be heard. Founded on the principles of trust, transparency, and accountability, we aim to challenge the status quo at every step and are looking for purpose-driven team members to share our journey in redefining the Healthcare data infrastructure.
About the Role
As Certify scales, we need to add rigor and structure to our operational processes to continue driving high customer satisfaction at increasingly attractive unit economics. We’re looking to hire an Operations Team Lead to lead a critical pod of our Credentialing team – someone who combines best-in-class people leadership with strong subject matter expertise and a relentless focus on speed and quality. This individual will oversee a production-focused pod made up of operations analysts (OAs).
The Credentialing Team Lead will oversee day-to-day credentialing operations, ensuring compliance with regulatory requirements and internal quality standards. This role requires strong leadership, direct client engagement, and hands-on expertise in credentialing processes. The Team Lead will act as a subject matter expert, guiding the team in meeting performance, quality, and compliance expectations.
What You'll Do
- People Management & Team Leadership:
- Lead and manage a team of Credentialing Specialists and Operational Analysts to ensure timely and accurate credentialing file processing.
- Provide coaching, mentoring, and training to team members to strengthen credentialing knowledge and regulatory understanding.
- Oversee credentialing workflows to ensure compliance with NCQA guidelines, state regulatory requirements, and client-specific policies.
- Facilitate company performance reviews, and partner with Operations Management to determine performance ratings for the OAs on your team and deliver performance review conversations directly to your team members.
- Host daily standups with your team as needed to review the previous day’s performance and align on priorities for the day ahead. Lead weekly performance reviews to recap results from prior week and identify improvement opportunities.
- Support onboarding of new hires, provide education and guidance during training, and participate in hiring processes for new OAs.
- Regularly review team performance data daily and weekly, communicating insights upward, downward, and laterally for alignment and accountability.
- Production Management:
- Responsible for meeting core performance metrics for the subset of clients supported by your pod, focusing on speed, quality, and efficiency of file processing. Continuously identify and drive improvements as volumes scale.
- Monitor contractual Service Level Agreement, turnaround times, and quality metrics; drive corrective actions to maintain compliance and efficiency.
- Partner with internal stakeholders to resolve escalations, streamline workflows, and improve operational outcomes.
- Oversee monthly ongoing monitoring and management of credentialing expirables.
- Maintain proactive communication with OAs to ensure productivity and coordinate with Credentialing Management to prioritize files.
- Identify process gaps and implement documented improvements.
- Facilitate team training sessions to strengthen skills and ensure process consistency.
- Create comprehensive SOPs and develop ad hoc reports to support operational needs.
What You'll Need
- Minimum 1–2 years of experience in credentialing, provider enrollment, or healthcare setting and compliance.
- Strong knowledge of NCQA guidelines and state/federal regulatory requirements related to credentialing.
- Demonstrated success in client engagement and managing client relationships.
- Prior leadership experience with ability to coach and develop a team. Passion for continuous improvement in metrics and process understanding.
- Hands-on and execution-focused approach in short term; strategic thinking for long-term success.
- Serve as primary point of contact for client engagement including client meetings, escalations, and satisfaction.
- Proven excellence in organization and attention to detail.
- Ability to manage multiple initiatives simultaneously and prioritize critical objectives.
- Strong organizational, analytical, and problem-solving skills.
- Excellent written and verbal communication skills.
- Ability to manage in production environment and oversee daily performance metrics.
Equal Opportunity
Certify is committed to creating an inclusive workplace where everyone feels valued and supported. As an equal opportunity employer, we celebrate diversity and warmly invite applicants from all backgrounds to join our vibrant community.
How to Apply
Please apply for this job through the following link: Apply for this job