Paradigm · 19 hours ago
Credentialing Operations Manager
Tampa, FL, USA
Full-time
Hybrid
Mid, Senior Level
$95K/yr - $110K/yr
3+ years expParadigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The Credentialing Operations Manager is responsible for leading and continuously improving clinician and facility credentialing programs while ensuring compliance with regulatory standards.
HealthcareHospitalHealth CareMedical
Responsibilities
Oversee and manage the initial credentialing process for all clinicians (physicians, advanced practice providers, allied health professionals) and healthcare facilities
Ensure all applications and supporting documentation are collected, verified, and maintained according to organizational policies and regulatory requirements
Coordinate and communicate with providers, facilities, and internal teams to resolve discrepancies and expedite credentialing timelines
Lead and manage periodic recredentialing of clinicians and facilities in compliance with organizational, state, and federal guidelines
Monitor upcoming recredentialing deadlines and proactively communicate with providers and facilities to ensure timely completion
Analyze data and develop process improvements to streamline recredentialing activities and enhance compliance
Develop and implement audit tools and protocols to assess delegated entities' compliance with credentialing standards
Conduct regular delegation audits, document findings, and report results to leadership and relevant stakeholders
Provide guidance and corrective action plans for delegated entities not meeting performance or compliance expectations
Maintain and update credentialing and recredentialing policies to reflect current regulations and best practices
Train and support credentialing staff on policies, procedures, and regulatory changes
Ensure all credentialing activities align with NCQA, URAC, The Joint Commission, and other relevant accreditation standards
Prepare for and participate in internal and external audits and surveys
Act as a primary point of contact for credentialing inquiries from providers, facilities, internal departments, and regulatory agencies
Provide regular updates and reports on credentialing status, compliance metrics, and audit outcomes to senior leaders
Mentor, train, and supervise team members directly and indirectly, review their work and provide effective constructive feedback to achieve their best performance and goal attainment
Set the tone for a strong Enterprise culture and high employee engagement
Ensure all team members understand, are trained in, and comply with Paradigm’s security requirements and policies
Ensure all team members have the minimum level of IT system access required to effectively complete their Paradigm responsibilities
Qualification
Required
Bachelor's degree in healthcare administration, business, or a related field
Minimum of 3–5 years of experience in credentialing operations
At least 2 years in a leadership or management role
Thorough understanding of credentialing requirements, accreditation standards, and regulatory guidelines (e.g., NCQA, URAC, CMS, The Joint Commission)
Proficiency in Microsoft Office suite (Excel, PowerPoint, Word)
Proficiency in data visualization tools (e.g. Power BI)
Strong ability to analyze complex data sets and derive actionable insights
Exceptional written and verbal communication skills
Experience with credentialing software and data management systems
Proven ability to work collaboratively with cross-functional teams in a fast-paced environment
Strong focus on accuracy and thoroughness in all deliverables
Preferred
Master's degree in healthcare administration, business, or a related field
Benefits
Health and wellness– We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
Financial incentives– Paradigm’s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
Volunteer time– We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.
Learning and development: One of Paradigm’s core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program.
Company
Paradigm
Paradigm achieves leading clinical and financial results for catastrophic and complex claims.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Neuberger Berman Capital Solutions
2025-07-02Private Equity
2018-09-20Acquired
Leadership Team
D
D. Nathan
Founder
Recent News
2025-12-10
2025-07-02
Company data provided by crunchbase