Credentialing and Enrollment Director

New

Skills

AI Automation CMS Regulations Credentialing Software Google Sheets Healthcare Operations Management Microsoft Excel Multi-State Licensure Management NCQA Standards Payer Enrollment Processes Registered Dietitian Credentialing

The Director of Credentialing and Enrollment will define and execute a strategic roadmap for transitioning to a tech-enabled operation. This role involves leading and mentoring the Credentialing & Enrollment team while overseeing the end-to-end enrollment process for various payers.

Key Responsibilities
  • Define and execute the strategic roadmap for credentialing and enrollment.
  • Lead and mentor the Credentialing & Enrollment team.
  • Oversee end-to-end enrollment processes for Medicare, Medicaid, and Commercial payers.
  • Act as the primary liaison for contract activations with payers.
  • Manage initial and re-credentialing applications for registered dietitians.
  • Conduct ongoing monitoring of licensure and certifications.
  • Maintain provider records in the credentialing database.
  • Ensure compliance with NCQA, URAC, and CMS standards through audit activities.
  • Utilize data to identify bottlenecks and optimize processes.
  • Lead the internal Credentialing Committee to ensure accurate provider verifications.
Required Skills & Qualifications
  • 7+ years in healthcare operations with 3+ years in leadership roles.
  • Deep knowledge of NCQA standards, CMS regulations, and credentialing processes.
  • Intermediate to advanced skills in Excel/Google Sheets and credentialing software.
  • Bachelor’s degree required; CPCS or CPMSM certification preferred.
  • Comfort with using AI for process automation.
  • Familiarity with 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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