Director, Credentialing Operations

Director, Credentialing Operations at TriWest Healthcare Alliance Director, Credentialing Operations at TriWest Healthcare Alliance in Billings, Montana Posted in 8 days ago.

Type:

Full-Time Job Description:

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary Responsible for leading and overseeing the operational performance of provider credentialing functions, including end-to-end credentialing and recredentialing processes, delegated credentialing oversight, ongoing monitoring, and provider data maintenance. Ensures timely and compliant credentialing operations through effective management of work production, service level agreements (SLAs), workload distribution, and performance metrics. Directs credentialing staff and external partners to meet operational targets while maintaining high standards for quality assurance. Oversee credentialing system operations, staff training and development, and continuous process improvement to optimize efficiency and accuracy. Leads the coordination and governance of credentialing committee activities and ensures consistent execution of credentialing policies and procedures. Monitors operational performance, implements corrective actions when needed, and drives accountability for quality, timeliness, and overall credentialing effectiveness across the organization. Represents the organization with professionalism and integrity in interactions with providers, vendors, and regulatory bodies, serving as a role model for leadership and organizational values both internally and externally.

Education & Experience Required:

• Bachelor's degree in business administration, healthcare administration, or related field or equivalent experience
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 5 years of experience in a managed care or payer environment
• 5+ years of progressively responsible people management experience to include managing leaders in the healthcare industry
• Minimum of 3 years of experience managing provider credentialing and data applications/systems
• Proven experience leading and managing large teams in a high-volume, production-driven environment
• Experience with URAC, NCQA, or other equivalent accreditation standards
• Experience in strategic planning, program design and management, and team leadership with a focus on leadership and staff development

Preferred:

Experience in government healthcare delivery programs, such as Veterans Affairs, TRICARE, or Medicare Key Responsibilities

• Provides strategic leadership and operational oversight for the Provider Network Management - Credentialing Department, ensuring alignment with organizational goals, regulatory requirements, and accreditation standards. Leads, mentors, and develops staff to achieve high performance, accountability, and continuous improvement.
• Directs end-to-end credentialing and re-credentialing operations, ensuring timely completion of credentialing activities in accordance with established service level agreements (SLAs), quality standards, and regulatory requirements.
• Oversees departmental productivity, work production, workload distribution, and operational performance through the development and monitoring of key performance indicators (KPIs), metrics, and service delivery targets.
• Ensures the quality, accuracy, and integrity of credentialing and provider data across credentialing and provider data management systems, including oversight of primary source verification, data entry, and provider record maintenance.
• Establishes and maintains robust quality assurance and audit processes to ensure credentialing activities meet internal standards as well as regulatory and accreditation requirements.
• Oversees end-to-end delegated credentialing program, including governance, monitoring, and auditing of network subcontractors and delegated entities to ensure compliance with contractual, regulatory, and accreditation requirements.

Directs credentialing audits for network subcontractors and delegated entities, including review of audit findings, development of corrective action plans, and reporting outcomes.

• Oversees the coordination and administration of Credentialing Committee activities, ensuring complete, accurate, and compliant credentialing files; development and management of meeting agendas and minutes; and strict adherence to committee governance policies, procedures, and documentation standards.
• Identifies operational risks, recurring issues, and workflow inefficiencies within credentialing processes, and lead the development and implementation of process improvements and system enhancements.
• Collaborates cross-functionally with Provider Services, Compliance, Legal, Medical Management, IT, and other operational areas to support enterprise initiatives and continuous improvement efforts.
• Fosters strong relationships with network providers, delegated entities, and internal stakeholders to ensure timely resolution of credentialing issues and to support a positive provider experience.
• Develops and delivers executive-level performance reports and dashboards that provide visibility into credentialing operations, service levels, quality outcomes, and operational trends for senior leadership and key stakeholders.
• Establishes staffing strategies and allocates resources to meet operational demands and service level commitments. Recruits, trains, coaches, and develops staff to ensure operational readiness and professional growth.
• Assesses and defines budgetary requirements to support departmental objectives, recommends annual funding needs with supporting business cases for system enhancements, and forecasts resource requirements in alignment with industry trends and emerging developments.
• Maintains regular and reliable attendance and demonstrates leadership that reflects organizational values and commitment to service excellence.

Competencies Coaching / Training /

Mentoring:

Leads team development through coaching, mentoring, and targeted training; provides ongoing feedback to enhance performance, build credentialing expertise, and ensure alignment with organizational goals and service expectations. Communication /

People Skills:

Effectively influences and aligns stakeholders across all levels, adapting communication style to diverse audiences and situations; demonstrates strong active listening and collaboration skills to resolve issues, build consensus, and drive operational outcomes.

Computer Literacy:

Demonstrates advanced proficiency in a multi-system environment, including Microsoft Office applications and credentialing platforms; effectively leverages internal systems, intranet resources, and industry tools to manage credentialing operations, ensure data integrity, and drive operational efficiency. Coping /

Flexibility:

Demonstrates resilience and flexibility in navigating changing priorities, complex situations, and diverse stakeholders; maintains a solutions-oriented, composed approach to problem-solving while ensuring continuity of operations and alignment with organizational objectives. Empathy /

Customer Service:

Promotes a provider- and stakeholder-centric approach by demonstrating empathy, active listening, and professionalism; ensures responsive, respectful service while balancing operational requirements and fostering positive, solution-oriented interactions. Independent Thinking /

Self-Initiative:

Demonstrates strong critical thinking and sound judgment to prioritize high-impact work and drive results; proactively identifies needs, solves problems, and mobilizes resources with minimal direction to achieve operational and organizational objectives.

Information Management:

Effectively manages and synthesizes complex credentialing and provider data to support accurate decision-making; translates insights into clear, actionable communication and drives sound operational and strategic conclusions.

Leadership:

Provides clear direction and strategic guidance while effectively leading and developing diverse employees; adapts leadership style to drive performance, accountability, and engagement through coaching and continuous development. Multi-Tasking /

Time Management:

Effectively prioritizes and manages high-volume credentialing activities to meet evolving deadlines, service level agreements, and operational demands in a fast-paced environment. Problem Solving /

Analysis:

Apply structured, data-driven analysis and sound judgment to identify root causes, resolve complex operational issues, and implement effective, sustainable solutions aligned with organizational priorities. Team-Building /

Team Player:

Builds high-performing teams by fostering collaboration, accountability, and shared commitment; positively influences others to align with organizational goals and drive collective results.

Technical Skills:

Deep expertise in provider credentialing principles, practices, and end-to-end credentialing and recredentialing processes; comprehensive knowledge of state and federal regulatory requirements and accreditation standards (e.g., URAC and NCQA); strong understanding of credentialing/provider data management platforms to ensure data integrity and operational efficiency; experience with cost management principles related to credentialing operations and vendor oversight; proven ability to lead large-scale implementations and operational transformation initiatives; demonstrated expertise in program development, process optimization, and continuous improvement methodologies; advanced proficiency in Microsoft Office Suite and enterprise tools supporting credentialing operations; strong capability in developing and mentoring staff, technical competencies, including credentialing standards, systems, and process execution.

Working Conditions Working Conditions:

• Availability to cover any work shift as needed
• Travel may be required
• May work within a standard office environment
• Extensive time utilizing a computer with prolonged sitting
• Must be able to obtain appropriate security clearance Company Overview Taking Care of Our Nation's Heroes.

It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996. DoD Statement Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Benefits We're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: Medical, Dental and Vision Coverage Paid time off 401(k) Retirement Savings Plan (with matching) Short-term and long-term disability, basic life, and accidental death and dismemberment insurance Tuition reimbursement Paid volunteer time TriWest job postings typically include a salary range, which can vary based on the specific role and location , but generally this position ranges from around $153,000 to $161,000 per year. Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.