Credentialing and Enrollment Director

New

Skills

AI Process Automation CMS Regulations Credentialing Software Google Sheets Healthcare Compliance Medicaid Enrollment Medicare Enrollment Microsoft Excel NCQA Standards Payer Contract Management

The Director of Credentialing and Enrollment will define and execute the strategic roadmap for transitioning credentialing and enrollment into a tech-enabled operation. This role involves leading and mentoring the Credentialing & Enrollment team, ensuring detail-orientation and accountability while overseeing the entire enrollment process for Medicare, Medicaid, and Commercial payers.

Key Responsibilities
  • Act as the primary liaison for contract activations, meeting payer density and requirements.
  • Oversee initial and re-credentialing applications for registered dietitians.
  • Conduct ongoing monitoring of licensure and certifications via relevant databases.
  • Manage delegated credentialing agreements ensuring compliance with industry standards.
  • Lead audit activities ensuring compliance with NCQA, URAC, and CMS standards.
  • Leverage data to identify bottlenecks and optimize processes using AI.
  • 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.
  • Deep knowledge of NCQA standards and CMS regulations.
  • 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.

No forms. Your profile is generated instantly.

Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: Months

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