Credentialing and Enrollment Director

New

Skills

AI Automation CMS Regulations Credentialing Software Data Analysis Excel Google Sheets Healthcare Operations Licensure Management NCQA Standards Payer Enrollment

The Director of Credentialing and Enrollment will define and execute the strategic roadmap for transitioning to a tech-enabled operation within the credentialing and enrollment processes. This role involves leading and mentoring a dedicated team while overseeing the end-to-end enrollment process for Medicare, Medicaid, and Commercial payers.

Key Responsibilities
  • Oversee initial and re-credentialing applications for registered dietitians.
  • Act as the primary liaison for contract activations meeting payer density and requirements.
  • Conduct ongoing monitoring of licensure and certifications via relevant databases.
  • Maintain and update provider records in the credentialing database and track license expirations.
  • Manage delegated credentialing agreements ensuring compliance with industry standards.
  • Lead audit activities ensuring compliance with NCQA, URAC, and CMS standards.
  • Act as an operational bridge between Sales, Clinical Quality, and Revenue Cycle Management.
  • Leverage data to identify bottlenecks and optimize processes using AI.
  • Lead the internal Credentialing Committee ensuring flawless provider verifications.
  • Ensure compliance with applicable laws and regulations.
Required Skills & Qualifications
  • 7+ years in healthcare operations, with 3+ years in a leadership role.
  • Proven track record in managing multi-state licensure and enrollment for a provider network.
  • Deep knowledge of NCQA standards, CMS regulations, and industry requirements.
  • Intermediate to advanced skills in Excel/Google Sheets and credentialing software.
  • Bachelor’s degree required; CPCS or CPMSM certification preferred.
  • Familiarity with credentialing processes specific to registered dietitians.
  • Comfort with using AI to automate processes.
  • Knowledge of nutrition-related certifications and continuing education requirements.

No forms. Your profile is generated instantly.

Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: Months

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