Director Credentialing and Professional Services

Credentialing Manager

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Provides leadership, management, and operational oversight of the System Credentialing Office and related professional services that support medical staff. This role ensures that all governance, credentialing and regulatory compliance activities are effectively coordinated and aligned with system and medical staff goals. The role requires strong leadership, collaboration, and knowledge of healthcare regulations and best practices.

What You Will Do

Serves as primary liaison with the outsourced Credentialing Verification Organization (CVO), escalating and resolving issues in partnership with CVO leadership. Monitors CVO performance against service level agreements (SLAs), turnaround times, and quality expectations.

Oversees the accuracy and integrity of provider data within credentialing system and ensures timely updates by hospitals and clients.

Oversees standardization and execution of credentialing processes across the system. Ensures credentialing and recredentialing activities meet federal, state, and accreditation standards (e.g., The Joint Commission, NCQA). Maintains working knowledge of governance documents such as bylaws, rules, and credentialing policies.

Works closely with medical staff leaders, department chairs, and committees. Supports the System Credentialing Committee, including preparation and follow-up on committee outputs.

Develops and leads initiatives that result in physician satisfaction with credentialing processes and professional services of medical staff office.

Effectively maximizes technology to improve accuracy and efficiency.

Coordinates with other departments to resolve credentialing issues.

Supports medical staff governance and quality improvement initiatives.

Supports System Peer Review committee and resulting outputs of peer review.

Serves as business owner of relationships, contracts and billing for credentialing clients, including owned and leased hospitals, partner hospitals and non-Avera clients.

Responsibilities include interviewing, hiring, developing, training, and retaining employees; planning, assigning, and leading work; appraising performance; rewarding and coaching employees; addressing complaints and resolving problems.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Bachelor's Healthcare Administration, Business or related field
• 3-5 years in credentialing or medical support services
• Minimum of 2 years in a leadership role

Preferred Education, License/Certification, or Work Experience:

• Certified Provider Credentialing Specialist (CPCS) - National Association of Medical Staff Services (NAMSS) Upon Hire
• Certified Professional Medical Services Management (CPMSM) - National Association of Medical Staff Services (NAMSS) Upon Hire

Expectations and Standards:

• Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera's values of compassion, hospitality, and stewardship.
• Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.
• Free health insurance options, for full-time single coverage on Avera High Deductible Health Plan
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law.