Director of Credentialing – Business Process Management
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Job Description
Director of Credentialing providing strategic and operational leadership over provider credentialing and enrollment functions for healthcare clients.
Responsibilities:
- Provide strategic and operational leadership over all provider credentialing, re-credentialing, and payer enrollment functions.
- Develop and execute the strategic vision for credentialing and enrollment service delivery.
- Serve as the senior point of escalation for client concerns.
- Lead client onboarding, including discovery of payer mix and provider roster assessment.
- Oversee the end-to-end credentialing lifecycle.
- Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state-specific standards.
- Direct all payer enrollment, re-enrollment, and revalidation activities.
- Recruit, train, mentor, and manage a team of credentialing specialists.
Requirements:
- Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
- 5–7+ years of progressive experience in provider credentialing and payer enrollment, including management-level responsibility.
- Demonstrated experience managing credentialing/enrollment operations in a vendor, outsourcing, or multi-client environment.
- Deep working knowledge of NCQA credentialing standards, CMS enrollment regulations, and CAQH/PECOS/NPPES systems.
- Proven ability to manage and develop teams of 10+ credentialing and enrollment professionals.
- Strong understanding of the provider revenue cycle and the downstream impact of credentialing and enrollment delays.
- Proficiency with credentialing software platforms and Microsoft Office Suite.
Benefits:
- Business Travel: Required - 0-50% depending on the month
- Professional development opportunities
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