Manager, Credentialing Data Integrity Services - (Medical Staff Credentialing Office)

Job Description:

Provides leadership and oversight of credentialing data integrity operations, ensuring reliable data, regulatory compliance, and streamlined processes that support efficient provider onboarding and ongoing performance management.

 

Principal Accountabilities:

Leadership & Oversight

• Provide direct oversight of the Credentialing Data Integrity team, including supervision, performance management, and workforce planning
• Establish team goals, monitor performance, and foster a culture of accountability and continuous improvement
• Manage staffing and resource allocation to ensure productivity and quality outcomes
• Develop training strategies and support professional development across Data Integrity roles

Operational Support & Training

• Ensure support for system users across credentialing workflows, applications, reporting, and Provider Hub access 
• Provide day-to-day operational support and assist users with Service Operations tickets related to:
  • Applications
  • Privilege requests
  • Credentialing workflows
  • Reporting
  • Provider Hub access
  • PDF forms, letters, and document upload issues
  • System performance/vendor escalation tickets
  • Data discrepancies (e.g. incorrect office addresses, fax and phone)
  • Duplicate records 
• Deliver end-user training and develop user guides and tools to support adoption and efficiency
• Translate technical system functionality into clear, user-friendly instructions

Data Governance & Integrity

• Ensure the accuracy, consistency, and integrity of credentialing data within CredentialStream and across downstream systems (e.g., Epic, web directories)
• Lead data validation, reconciliation, and cleanup initiatives
• Maintain accountability for enterprise credentialing data standards and governance practices
• Resolve complex data discrepancies and serve as escalation point for data-related issues

Operations & Process Optimization

• Lead the design, implementation, and optimization of credentialing workflows and data processes
• Identify inefficiencies and implement automation and standardization strategies
• Partner with credentialing teams to improve turnaround times and reduce manual work
• Oversee development and maintenance of forms, templates, and workflows

Systems & Reporting

• Oversee department website content (internal and external) related to credentialing resources
• Oversee reporting and analytics to support operations, leadership decision-making, and audit readiness
• Develop dashboards and deliver routine and ad hoc reports on data integrity metrics
• Collaborate with IT, Epic, Revenue Cycle, and related teams to enhance system integration and interoperability
• Support system upgrades, enhancements, and issue resolution in partnership with vendors and IT

Regulatory Compliance & Audit Readiness

• Ensure compliance with TJC, CMS, DOH, and NCQA standards
• Support audits by preparing documentation, reports, and credentialing file data
• Develop and maintain policies, procedures, and standard operating documentation

Collaboration & Stakeholder Engagement

• Serve as a subject matter expert and primary liaison for credentialing data integrity 
• Engage stakeholders across Medical Staff Services, IT, Risk Management, and operational teams
• Support organizational initiatives related to onboarding, credentialing optimization, and data transparency

Additional Responsibilities

• Ensure adherence to budgetary guidelines for operational and project-related activities
• Perform other duties as assigned

Education/Experience:

• Bachelor’s degree in Data Analytics, Healthcare Administration, Computer Science required. Master’s Degree Preferred

• 5 years of credentialing database or data management experience required.
• 2-4 years working with credentialing systems (e.g. CredentialStream, MDStaff) and EHRs (e.g., Epic)
• Experience in healthcare credentialing, privileging, or medical staff operations preferred

• 5 years of supervisory experience working in an organization of size and complexity comparable to Atlantic Health preferred.