About the Role
The role involves leading national credentialing and enrollment functions, managing teams, improving processes, and ensuring alignment with regulatory standards and business goals.
Responsibilities
- Lead end-to-end provider credentialing and enrollment operations
- Ensure compliance with federal, state, and payer-specific requirements
- Manage a team of credentialing specialists and enrollment coordinators
- Develop and implement scalable operational workflows
- Collaborate with legal and compliance teams on regulatory updates
- Oversee audit readiness and response for credentialing records
- Drive process improvements using data and performance metrics
- Partner with IT to enhance enrollment systems and automation
- Maintain relationships with state licensing boards and primary sources
- Streamline provider onboarding timelines
- Ensure accurate data entry and maintenance in credentialing databases
- Develop training materials for internal staff and stakeholders
- Monitor performance against key operational indicators
- Support payer credentialing applications and reappointments
- Lead cross-functional initiatives to improve provider data integrity
- Manage vendor relationships related to credentialing services
- Serve as escalation point for complex credentialing cases
- Ensure adherence to NCQA and other accreditation standards
- Oversee provider file audits and documentation completeness
- Guide policy development for credentialing protocols
- Support mergers, expansions, or new market entries
- Coordinate with network management on provider status changes
- Maintain up-to-date knowledge of CMS and insurance regulations
- Facilitate communication between clinical and administrative teams
- Promote a culture of accuracy, timeliness, and accountability
Compensation
Competitive salary and benefits package
Work Arrangement
Remote with flexibility for hybrid options
Team
Part of the operations leadership team focused on scaling healthcare access
About the Team
This role operates within a growing healthcare operations division focused on expanding access to nutrition and medical care services through technology-enabled solutions.
Growth Opportunity
The position offers leadership exposure across national provider networks and the chance to shape scalable systems in a rapidly evolving healthcare environment.
Not specified
