Credentialing and Enrollment Director

New

Skills

AI Optimization CMS Regulations Credentialing Software Data Analysis Excel/Google Sheets Healthcare Operations Multi-State Licensure NCQA Standards Payer Enrollment Provider Credentialing

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

Key Responsibilities
  • Define and execute the strategic roadmap for credentialing and enrollment.
  • Lead and mentor the Credentialing & Enrollment team, fostering detail-orientation and accountability.
  • Oversee end-to-end enrollment process for Medicare, Medicaid, and Commercial payers.
  • Act as 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.
  • 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; 3+ years in a leadership role overseeing Credentialing and Payer Enrollment.
  • 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.

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Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: Months

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