Credentialing and Enrollment Director

New

Skills

AI Process Automation CMS Regulations Commercial Payer Relations Credentialing Software Data Analysis Healthcare Operations Licensure Tracking Medicaid Enrollment Medicare Enrollment NCQA Standards

The Director of Credentialing and Enrollment will define and execute a strategic roadmap for transitioning to a tech-enabled operation, overseeing the end-to-end enrollment process for various payers. This role involves leading and mentoring the Credentialing & Enrollment team, ensuring compliance with industry standards, and optimizing processes using data and AI.

Key Responsibilities
  • Define and execute the strategic roadmap for credentialing and enrollment operations.
  • Lead and mentor the Credentialing & Enrollment team, promoting detail orientation and accountability.
  • Oversee the enrollment process for Medicare, Medicaid, and Commercial payers.
  • Act as the primary liaison for contract activations, ensuring compliance with payer requirements.
  • Manage initial and re-credentialing applications for registered dietitians.
  • Conduct ongoing monitoring of licensure and certifications through relevant databases.
  • Track and ensure timely license and certification renewals.
  • Manage delegated credentialing agreements, ensuring compliance with standards.
  • Lead audit activities to ensure adherence to NCQA, URAC, and CMS standards.
  • Act as an operational bridge between Sales, Clinical Quality, and RCM teams.
Required Skills & Qualifications
  • 7+ years in healthcare operations with at least 3 years in a leadership role.
  • Proven experience in managing multi-state licensure and enrollment processes.
  • 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.

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Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: Months

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