Credentialing Supervisor - 100% onsite at Verda Healthcare Inc – Huntington Beach, California

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Credentialing Supervisor to join our growing company with many internal opportunities

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview
This Credentialing Supervisor is responsible for leading multi-state provider credentialing and recredentialing activities while serving as a subject matter expert for credentialing operations. This role ensures accurate, timely, and compliant credentialing in accordance with CMS, NCQA, state regulations, and Verda Healthcare policies.

The Credentialing Supervisor supports audit readiness for both the health plan and delegated physician organizations, interfaces with the CVO, resolves escalated credentialing issues, and partners Provider Services, Compliance, Medical Management, and Operations teams to support network growth and market expansion initiatives.

This position reports to the Senior Director, Provider Network & Contracting.

Responsibilities:

Advanced Credentialing Operations

· Lead and oversee all hospital and ancillary provider credentialing across multiple states.

· Process incoming hospital and ancillary provider credentialing applications in accordance NCQA standards, Medicare Advantage regulatory requirements, and internal policies and procedures. This includes verification of all required documentation such as licenses, certifications, registrations, permits, and Certificated of Insurance (COI) to ensure they are current and compliant.

· Prepare and submit completed credentialing files to the contracted Credentialing Verification Organization (CVO) for primary source verification.

· Maintain accurate logging and tracking of all credentialing and recredentialing activities within the credentialing tracker. Develop and produce monthly reports summarizing credentialing approvals, denials, and status updates.

· Compile and present completed credentialing files to the Credentialing Committee for formal review and final determination.

· Draft and distribute credentialing approval and denial notifications to provider in accordance with regulatory and policy requirements.

· Conduct provider outreach and follow up to obtain missing and updated documentation necessary to complete credentialing (e.g, updated COI, licenses, certifications)

· Serve as an escalation point for challenging or high-risk credentialing cases.

· Manages and maintains relationship with CVO partner(s), including oversight of performance expectations, and review and validate monthly invoices.

· Periodic review and update of credentialing-related policies and procedures to ensure ongoing compliance.

Subject Matter Expertise & Quality Leadership

· Act as a subject matter expert on CMS Medicare Advantage requirements, NCQA credentialing standards, and state regulatory guidelines.

· Support audit readiness, mock audits, and regulatory reviews by ensuring provider files meet documentation and timeliness standards.

· Identify quality gaps, root causes, and compliance risks; recommend and help implement corrective actions.

Mentorship & Team Support

· Mentor and support Credentialing Specialists by providing guidance, case reviews, and on-the-job coaching.

· Support training and onboarding of new team members.

· Contribute to team huddles, best practice sharing, and continuous improvement initiatives.

Cross-Functional Partnership

· Partner closely with Contracting, Network Development and Provider Services to support provider onboarding, contracting timelines, and network adequacy goals.

· Collaborate with Compliance, Legal, and Operations on escalated credentialing issues and regulatory interpretation.

· Serve as a liaison between credentialing operations and internal stakeholders to ensure timely resolution of issues.

Performance & Process Improvement

· Consistently meet or exceed productivity, quality, and turnaround time (TAT) goals.

· Identify opportunities to streamline workflows, improve provider experience, and enhance data accuracy.

· Participate in special projects related to system enhancements, delegation oversight, and market expansion readiness.

Minimum Qualifications

· Associate’s degree required, or

o Bachelor’s Degree in Healthcare Administration, Business, Public Health, or related field preferred.

· Minimum 3–5 years of progressive provider credentialing experience within managed care, health plans, MSOs, or healthcare organizations.

· Demonstrated hands-on experience with CMS Medicare Advantage requirements and NCQA credentialing standards.

· Experience supporting audits, regulatory reviews, credentialing committees, and complex case resolution strongly preferred.

· Prior experience mentoring or training peers preferred.

· Advanced knowledge of facility, provider credentialing, recredentialing, primary source verification, and delegated credentialing oversight.

· Strong familiarity with CAQH, NPPES, OIG, SAM, state licensing boards, and accreditation standards.

· Exceptional attention to detail and ability to manage complex cases and competing priorities.

· Strong written and verbal communication skills, including professional provider communication.

· Proficiency with Microsoft Office (Word, Excel, Outlook, Teams) and credentialing systems or provider data platforms.

· Ability to work independently and serve as a trusted resource in a regulated, fast-paced environment.

Professional Competencies

· Integrity and Trust

· Attention to Detail

· Provider and Member Focus

· Accountability and Ownership

· Written and Oral Communication

· Critical Thinking and Problem Solving

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time employment

Location: Huntington Beach, CA

Compensation Range:

$70,304 - $85,000 annually

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.

Benefits:

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental Insurance
• Vision insurance
• Life insurance

Schedule:

• Full-time onsite (100% in-office)
• Hours of operations: 9am – 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

*Other duties may be assigned in support of departmental goals.