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For more insights about Evolent Health, click on Life At Evolent ( to learn more! The Manager, Credentialing Operations collaborates with Provider Data Management (PDM), Market Operations, Shared Service team, and our external business partners to monitor operations, resolve service barriers, develop solutions to improve effectiveness, and identify continuous improvement initiatives to increase service and operational level agreements.
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The Manager, Credentialing Operations will be a dynamic role that will work directly with our partners, focus on coordinating, monitoring, trending, and supporting our day-to-day credentialing operations.
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Serve as an expert in the administration and maintenance of credentialing and provider data management systems, including the Council for Affordable Quality Healthcare (CAQH), Credentialing System, sPayer, Symplr and proprietary claim systems.
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Experience working within a health plan, managed care organization, provider operated healthcare environment or Third-Party Administrator (TPA)/Business Process Outsourcing (BPO) - Required. Three (3) to five (5) years of credentialing and/or provider enrollment leadership experience with physicians, Advance Practice Clinicians (APCs), behavioral health, and/or allied providers, in a fast-paced health care environment (hospital, provider group, health plan) - Required.
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Certified Provider Credentialing Specialist (CPCS) certification - Preferred. Experience with Medicare Advantage and Medicaid plans - Preferred. Work with Senior leadership to support certification and accreditation processes with National Committee for Quality Assurance (NCQA.
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Experience working with senior leadership to support certification and accreditation processes with National Committee for Quality Assurance (NCQA)- Preferred. We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router.
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This position reports to the Associate Director, Credentialing Operations. Prepare key credentialing operational reports for internal and external partners that drive business decisions and impact strategic planning.
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Plan, organize, direct, and effectively manage the responsibility for overseeing the day-to-day operations, hiring, team building activities, training, supervision of department staff, corrective action process, mentoring, coaching employees, and completing performance reviews.
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Accountable for establishing, contributing, and implementation of standards applicable to provider staff relating to credentialing and administrative functions in compliance with credentialing, regulatory and accreditation requirements.
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Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones.
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Assure credentialing activities are integrated and administered by the department in partnership with partner Committees, including Credentials and Quality Improvement Committees (QIC). That's one reason why diversity and inclusion are core to our business.
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The expected base salary/wage range for this position is $65,000 up to 80,000. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations. Extensive knowledge of computers and related software applications, such as Word, PowerPoint, Excel, Project - Required.
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Maintain comprehensive knowledge of both state and federal statutory requirements to ensure that all legal, licensure and accreditation standards, due dates and deadlines are met. As part of our total compensation package, Evolent is proud to offer comprehensive benefits to qualifying employees.
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High school graduation or completion of General Equivalency Degree/Diploma (GED) - Required. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done.
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If you need reasonable accommodation to access the information provided on this website, please contact recruiting@evolent.com for further assistance. Drop off your contact information and resume and we will reach out to you if we find the perfect fit.
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Title: manager Company: Evolent Health
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