Credentialing Lead at Brigade Health

Santa Ana, California, United States -

Full Time

Start Date

Immediate

Expiry Date

30 Apr, 26

Salary

140000.0

Posted On

30 Jan, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider Credentialing, Payer Enrollment, Compliance Management, Process Improvement, Audit Readiness, Team Leadership, Workflow Optimization, Credentialing Policies, Risk Management, Healthcare Operations, Performance Metrics, Documentation Standards, Multi-State Operations, Credentialing Software, Accreditation Requirements, Training Development

Industry

Hospitals and Health Care

Description

Position Summary The Credentialing Lead is a senior healthcare operations leader responsible for provider credentialing, recredentialing, and payer enrollment across a growing medical organization. This role owns the end-to-end credentialing lifecycle for physicians and advanced practice providers (APPs) and ensures compliance with NCQA, CMS, state licensing boards, and payer requirements. This position focuses on process improvement, compliance, audit readiness, and scalability, ensuring credentialing and enrollment operations support organizational growth without delays or regulatory risk. This role is eligible for a performance-based bonus incentive. Key Responsibilities Provider Credentialing & Enrollment Own the full provider credentialing and recredentialing process for physicians, APPs, and clinical staff Manage payer enrollment with commercial, Medicare, and Medicaid plans Serve as the credentialing subject-matter expert for regulatory and accreditation requirements Maintain credentialing policies, procedures, and documentation standards Credentialing Operations & Process Improvement Evaluate and improve credentialing workflows, cycle times, and handoffs Standardize credentialing and enrollment processes to support multi-state growth Develop SLAs, checklists, escalation paths, and quality controls Partner with HR, Medical Operations, Revenue Cycle, Compliance, Legal, and Contracting Compliance, Risk Management & Audits Ensure compliance with NCQA, CMS, state medical boards, and payer credentialing requirements Maintain audit-ready credentialing files and lead internal and external audits Identify credentialing and enrollment risks and implement mitigation plans Oversee clinician supervisory roster management Team Leadership & Credentialing Management Lead, train, and develop credentialing and enrollment staff Establish performance metrics and accountability Create documentation and training to reduce operational risk Scale credentialing team structure and workflows (Director level) Reporting & Stakeholder Communication Track and report on credentialing KPIs (time to credential, time to enroll, backlog, expirables) Provide clear status updates to executive and clinical leadership Set realistic credentialing and enrollment timelines with stakeholders Minimum Qualifications 5+ years of experience in provider credentialing and payer enrollment Associate’s degree required; Bachelor’s degree in Healthcare Administration, Business, or related field preferred Proven experience managing provider credentialing operations in a healthcare or medical group setting Strong knowledge of NCQA, CMS, payer enrollment, and state licensing requirements Experience leading credentialing teams and improving operational performance Strong skills in process design, workflow optimization, and compliance management Preferred Qualifications CPCS, CPMSM, or equivalent credentialing certification Experience in healthcare services, medical groups, MSOs, or value-based care organizations Experience supporting multi-state provider operations Experience implementing or optimizing credentialing software or enrollment platforms Pay Range for Posted Region $105,000—$140,000 USD

Responsibilities

The Credentialing Lead is responsible for managing the full provider credentialing and recredentialing process, ensuring compliance with various regulatory requirements. This role also focuses on process improvement and operational scalability to support organizational growth.