Who we are:
UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.
We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.
Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.
You are:
An experienced Director of Provider Data Management and Credentialing who will lead and oversee the day-to-day operations of provider data management, and credentialing. This is a shared service position with responsibility of supporting multiple health plans. You will be responsible for driving strategy and providing oversight of an onshore and offshore team.
As the Director, you will have the responsibility for ensuring the integrity and compliance of all provider data, overseeing credentialing processes, and driving continuous improvements through technology, automation and AI-driven solutions. You are a strategic thinker with a passion for innovation and team development.
The Opportunity:
· Lead, manage, and mentor a high-performing team in the provider data management and credentialing workstreams. · Develop and execute strategies to optimize provider data and credentialing accuracy and timeliness, and operational processes. · Oversee the full continuum of operational activities related to credentialing, and provider data management. · Align with client long-term goals and strategic plans to achieve success in their business. · Ensure the accuracy, integrity, and timeliness of provider data for all contracted and non-contracted providers. · Implement systems and processes for real-time data validation and updates, leveraging AI technologies to streamline data management workflows. · Continuously monitor provider data for accuracy, completeness, and compliance with industry regulations. · Develop and manage reporting and metrics for provider data management performance. · Ensure timely completion of credentialing applications and recredentialing cycles. · Oversee the management the credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems. · Monitor credentialing and re-credentialing process with CVO and credentialing team to resolve issues and improve processes. · Champion the integration of AI and machine learning solutions to optimize provider data management and credentialing. · Collaborate with IT and data analytics teams to develop and implement AI models that drive decision-making, automate repetitive tasks, and enhance operational efficiency. · Stay current on AI and healthcare technology trends, recommending and implementing cutting-edge solutions to continuously improve processes. · Ensure that all provider data management and credentialing practices comply with applicable laws, regulations, and accreditation standards. · Lead audits and ensure that the department adheres to internal controls, compliance requirements, and quality standards. · Implement risk mitigation strategies related to provider data management, and credentialing. · Collaborate with other departments such as Technology Operations, Claim Operations and Compliance to align operations and optimize processes. · Work closely with system vendors to influence the product roadmap and defect resolution. · Partner with clinical operations, network development, and other stakeholders to ensure provider-related workflows are integrated and streamlined across operations
You bring:
· At least 15 years of progressive experience in health plan operations, with a focus on provider data management, credentialing, or network operations.
· Proven experience managing teams and overseeing large-scale operations.
· Strong background in AI-driven process optimization, automation, and machine learning applications within healthcare operations.
· Knowledge of industry regulations (e.g., NCQA, URAC) and experience ensuring compliance in credentialing and provider data management.
· Proficiency in AI, machine learning, and automation tools applied to healthcare operations.
· Experience with provider data management systems (e.g., Santech, CAQH, Availity, NaviNet) and credentialing platforms.
· Familiarity with healthcare data standards (e.g., HL7, FHIR) and interoperability.
· Ability to analyze and interpret data, track performance metrics, and make data-driven recommendations for improvement.
· Strong leadership and team management skills with the ability to inspire and mentor staff.
· Strategic thinker with a proven ability to drive change, solve complex problems, and improve operational processes.
· Excellent communication, collaboration, and interpersonal skills.
Preferred Skills:
Experience working with AI/ML teams or vendors to integrate automation technologies into credentialing and provider data workflows. Experience with business intelligence tools such as Tableau, Power BI etc. Proficiency with MS Office Suite.
Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.
Location: Remote
Compensation Range: $128,000 - $196,000
Benefits
Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.
Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching.
Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.
Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).
All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.
What We Believe
At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.
Guiding Principles
These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.
· Simplicity
Simplifying complexity underlines everything we do—this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.
· Integrity
Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.
· People-Centricity
Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.
· Leadership
Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a brave choice to ‘own’ all aspects of our work, ensuring we take full responsibility for everything we handle.
Mission
A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well-being.
Equal Employment Opportunity Statement
UST HealthProof is an Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances.
UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.
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