Manager, Quality Assurance (Credentialing)
symplr
Quality Assurance
United States
USD 55k-75k / year
Manager, Quality Assurance (Credentialing)
- ID
- 2026-2423
- Category
- Credentialing
- Position Type
- Regular Full-Time
- Min
- USD $55,000.00/Yr.
- Max
- USD $75,000.00/Yr.
Overview
The Manager, Quality Assurance will be responsible for overseeing the quality assurance function within the credentialing department; this includes developing and implementing quality assurance strategies, plans, and processes to ensure high quality standards are met for all credentialing and primary source verification activities. This role also provides oversight of delegation audits, sub delegation audits, sanctions monitoring, and credentialing data integrity reviews to ensure compliance with regulatory and accreditation requirements. Leads a team to conduct audits, identify issues, and drive continuous improvement across all credentialing and business operations processes.
Duties & Responsibilities
- Develop quality assurance plans and audit methodologies for credentialing operations, delegated entities, and subdelegated arrangements
- Lead and mentor a team of credentialing quality assurance specialists, providing guidance and oversight
- Conduct comprehensive delegation and sub delegation oversight audits to ensure compliance with NCQA, CMS, federal, and state requirements
- Oversee routine sanctions monitoring programs, including OIG, SAM, state exclusions, and license sanctions
- Perform credentialing information integrity audits to validate accuracy, completeness, and consistency of provider data across systems in accordance with NCQA standards
- Execute business operations audits to assess process effectiveness, identify gaps, and recommend improvements
- Collaborate with credentialing operations leadership to ensure quality standards and metrics are consistently met
- Define and track key quality metrics and proactively identify areas for improvement
- Ensure compliance with NCQA, CMS, federal, and state regulations related to credentialing and delegated oversight
- Stay current on industry trends, best practices, and tools for credentialing quality assurance
- Manage QA resources effectively and efficiently to meet department goals
- Foster a culture of quality, compliance, and continuous improvement within the credentialing department
Skills Required
- Bachelor’s Degree or an equivalent number of years of relevant experience
- Five years of experience in healthcare credentialing, including at least two years in a quality assurance role
- Strong knowledge of NCQA, CMS, federal, and state credentialing regulations and standards
- Proven track record of leading and mentoring quality assurance specialists
- Expertise in developing and executing credentialing quality assurance plans and audits, including delegated and subdelegated oversight
- Strong data analysis skills with the ability to identify trends and issues
- Excellent problem‑solving, communication, and leadership skills
Desired Skills and Qualifications:
- Experience with credentialing software and databases
- Lean Six Sigma or other process improvement certification
- Certified Provider Credentialing Specialist (CPCS) certification
- Experience with delegated credentialing oversight and sanctions monitoring programs
- Knowledge of provider enrollment and network management
Min
Max
Options
The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.
Applicants must be authorized to work in the U.S. on a full-time basis without the need for current or future sponsorship.
About symplr:
symplr is revolutionizing healthcare operations with a first-of-its-kind platform that drives effective, efficient, and connected workflows while increasing operational benefits and scaling clinical, financial, and quality outcomes—driving value where it matters most.
We are a remote-first company with employees working across the United States, India, and the Netherlands. Guided by values, we focus on teamwork, championing our customers, being rooted in action and outcomes, overcoming challenges, and leading through equality and integrity. Read more about symplr's culture and values at symplr.com/careers.
Perks & Benefits:
- Company Sponsored Medical, Dental & Vision
- Safe Harbor 401K with Employer Matching up to 5%, eligible upon hire with immediate vesting
- HSA Employer Contributions, Employer Paid Life, Short-term and Long-term Disability, and AD&D Insurance Plans
- Permissive Time Off Plans, Volunteer Time Off, & 12 Paid Holidays
- Fully Paid Medical Leaves of Absence and Bonding Leaves for new parents
- Tuition Assistance & Continuing Education Reimbursement available
- Additional Employer-Paid Programs: Cleo Family Services, Care@Work Memberships, Headspace Memberships, LifeMart Discounts, and more!
symplr is an Equal Opportunity/Affirmative Action Employer. We consider applicants without regard to race, color, religion, age, national origin, ancestry, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, veteran status, disability, genetic information, citizenship status, or membership in any other group protected by federal, state or local law.
As an ongoing commitment to reasonably accommodate individuals with disabilities, symplr has established alternative methods to complete the application process. Disabled applicants needing assistance are encouraged to call 281.863.9500 if further assistance is required.
To all recruitment agencies: we do not accept resumes or partnership opportunities. Please do not forward resumes to symplr or any of our employees. We are not responsible for any fees related to unsolicited resumes.
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