Director of CredentialingLocation Type: Remote (Must Resides in the United States) The Role:As the Director of Credentialing, you will provide strategic leadership and oversight of provider credentialing, enrollment, delegated credentialing, and compliance programs across the organization. In this role, you will ensure regulatory and payer compliance, support organizational growth initiatives, strengthen delegated payer partnerships, and drive operational excellence through process improvement, automation, and data-driven decision-making.
Success in this role requires deep expertise in provider enrollment, delegated credentialing, payer relations, healthcare compliance, and team leadership, along with the ability to build strong partnerships across the organization. Your leadership will play a critical role in enabling organizational growth, maintaining compliance excellence, and advancing our mission to deliver high-quality care to the communities we serve.
What You'll Do:- Provide strategic leadership for provider credentialing, enrollment, recredentialing, delegated credentialing, and compliance programs, ensuring alignment with organizational goals and growth initiatives.
- Lead, develop, and mentor a high-performing credentialing team while fostering a culture of accountability, collaboration, continuous improvement, and exceptional service.
- Oversee provider enrollment and credentialing operations, ensuring timely, accurate, and compliant onboarding, recredentialing, ongoing monitoring, and maintenance of provider records across commercial, government, and delegated payer networks.
- Serve as the organization's subject matter expert on credentialing, provider enrollment, delegated credentialing, NCQA standards, and regulatory requirements, ensuring compliance with federal, state, payer, and accreditation standards.
- Direct delegated credentialing programs and payer relationships, including audit readiness, performance reporting, roster management, issue resolution, and ongoing compliance with delegation agreements.
- Partner cross-functionally with Operations, Revenue Cycle, Compliance, Legal, Human Resources, Clinical Leadership, and Payer Contracting to support provider onboarding, clinic growth initiatives, acquisitions, relocations, closures, and network participation strategies.
- Establish, monitor, and report on key performance indicators related to credentialing timeliness, enrollment accuracy, audit performance, provider readiness, compliance, and revenue cycle outcomes.
- Lead departmental process improvement, automation, and technology initiatives that enhance operational efficiency, improve provider experience, strengthen compliance, and support organizational scalability.
- Develop and maintain credentialing policies, procedures, quality standards, and corrective action plans to ensure audit readiness, mitigate risk, and promote operational excellence.
- Build strong relationships with providers, executive leadership, field operations teams, and payer partners while influencing stakeholders and driving solutions that improve provider access, reimbursement, and business performance.
- Other projects and duties as assigned.
Who You Are:- Bachelor's degree in Healthcare Administration, Business Administration, Revenue Cycle Management, or a related field; an equivalent combination of education and experience may be considered.
- 8+ years of progressive experience in healthcare credentialing, provider enrollment, delegated credentialing, provider operations, or revenue cycle management.
- 5+ years of leadership experience managing credentialing, provider enrollment, or healthcare operations teams.
- Demonstrated success leading process improvement initiatives, driving operational efficiencies, and managing cross-functional projects.
- Experience supporting large, multi-state healthcare organizations, preferably within an outpatient or ambulatory care environment.
- Strong experience managing delegated credentialing programs, payer relationships, and regulatory audits for commercial and government health plans.
- Deep knowledge of NCQA credentialing standards, delegated credentialing requirements, accreditation processes, and audit readiness activities.
- Experience utilizing credentialing and enrollment platforms such as CredentialStream, CAQH, PECOS, NPPES, Availity, and commercial payer portals.
- Experience supporting provider onboarding, de novo clinic openings, acquisitions, relocations, ownership changes, and other organizational growth initiatives.
- Working knowledge of Medicare DMEPOS enrollment, EFT/CEDI processes, provider data management, and ongoing compliance monitoring programs.
Nice to Haves:- CPCS or CPMSM certification.
Why You'll Love Working Here- The chance to directly shape our organization's growth by hiring the talent that drives our mission.
- Opportunities to stretch your skills-whether you're building pipelines, designing sourcing strategies, or advising leadership.
- A collaborative team environment where your ideas are valued.
- Competitive compensation, comprehensive benefits, and ongoing professional development.
Benefit Offerings:- Annual paid Charity Day to give back to a cause meaningful to you
- 100% employer paid medical health insurance premium option available
- Dental and Vision insurance
- 401(k) with company match
- Generous PTO and paid holidays
- Supportive team and leadership invested in your success
Benefits and eligibility are dependent on employment status and pay class (full-time, part-time, or PRN). Specific details will be provided during the hiring process.
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