HR Alliance, LLC · 2 months ago
Healthcare Operations Manager
Flint, MI
Full-time
Onsite
Senior Level
$60K/yr - $65K/yr
5+ years expHR Alliance is an organization focused on healthcare operations, specifically in navigating regulations and managing provider credentialing. The Healthcare Operations Manager will oversee compliance and credentialing processes, ensuring organizational adherence to state and federal laws while optimizing provider onboarding workflows.
ConsultingHuman ResourcesOutsourcing
Responsibilities
Stay abreast of federal and state healthcare laws and regulations including HIPAA, HITECH, False Claims Act, EMTALA, and others as applicable
Develop, update, and enforce compliance policies, standard operating procedures, and internal controls to meet regulatory requirements
Oversee internal monitoring, audits, investigations, and corrective action plans to address compliance risks
Serve as the organization’s liaison to regulatory bodies and manage site visits or inquiries from oversight agencies
Lead all credentialing functions for providers seeking participation with private insurers as well as Medicare, Medicaid, and other government payers
Oversee primary source verification of credentials—licensure, education, training, board certifications, malpractice history, and NPDB checks
Ensure structured review of credentials through internal committees, and manage approval workflows for clinical privileges and payer panel access
Ensure consistent re-credentialing, license renewals, and data accuracy in the credentialing database, maintaining alerts and timely updates
Develop efficient credentialing workflows and systems to reduce provider onboarding turnaround time
Coordinate across departments—clinical, billing, compliance, legal—to ensure credentialing aligns with revenue cycle and compliance goals
Manage vendor relationships for credentialing software or third-party verification services
Implement accreditation standards (e.g., EHNAC) where relevant to credentialing operations
Train team members on regulatory updates, credentialing best practices, and documentation standards
Conduct regular audits to identify gaps in credentialing or compliance processes and implement corrective actions
Provide periodic reporting to leadership on credentialing timelines, compliance issues, regulatory changes, and audit findings
Supervise credentialing specialists, compliance analysts, and operations support staff
Collaborate with compliance, legal, finance, and clinical departments to align credentialing operations with strategic and regulatory priorities
Foster continuous improvement and a culture of compliance awareness across the organization
Qualification
Required
Bachelor's degree in Health Administration, Healthcare Management, Nursing, Public Health, or related field
Minimum 5 years of progressive experience in healthcare operations, provider credentialing, and/or compliance management
Proven track record managing credentialing for both private and government payers
Deep understanding of healthcare regulatory landscape including HIPAA, HITECH, Stark Law, False Claims Act, EMTALA, and CMS credentialing guidelines
Experienced in primary source credentialing, NPDB querying, accreditation standards (e.g., EHNAC)
Proficient with credentialing platforms, provider enrollment systems, and compliance tracking tools
Excellent organizational, project management, and analytical skills
Strong leadership and team-building capabilities
Effective communicator with the ability to influence stakeholders across departments
High ethical standards, discretion, and sound judgment in sensitive regulatory environments
Preferred
Master's degree (MHA, MPH, or MBA)
Certified in Healthcare Compliance (CHC), Certified Professional Compliance Officer (CPCO), or similar certifications
Company
HR Alliance, LLC
Does your company have HR questions that you can’t answer? Need additional help staying compliant or implementing programs? Don’t have the financial ability to hire on a full team of HR professionals? HR Alliance, LLC is your trusted human resources partner.
2-10 employees
Funding
Current Stage
Early StageLeadership Team
Kimberly Ratcliffe
Chief Operating Officer
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