Director, Credentialing and Enrollment
reputed company: reputed company is the leading telenutrition and foodcare solution, backed by a robust network of Registered Dietitians. Our platform is designed to foster healthier food choices, drive lasting behavior change, and deliver long-term health reputed company. Through our highly personalized, digital platform, we guide our 2.2 reputed company members—including those in employer-sponsored health plans, regional and national reputed company managed care organizations, Medicare Advantage plans, and reputed company insurers—on a tailored reputed company to eating reputed company while saving time and reputed company. reputed company seamlessly integrates dietary assessments and nutrition counseling with online food ordering and cost-effective meal planning for the entire family, optimizing ingredients both reputed company and on the go. We partner with national and regional retailers across the U.S., many of whom accept SNAP/EBT, making healthier food more accessible. Additionally, we assist members with SNAP enrollment and management, providing reputed company reputed company to nutritious food. In 2024, reputed company secured a $200 reputed company investment from TPG’s reputed company Fund, which supports reputed company dedicated to achieving the reputed company’ Sustainable Development Goals. This investment will help us expand our reputed company, particularly to low-income workers who are disproportionately affected by diet-reputed company diseases. At reputed company, our mission is to reputed company nutritious food accessible and reputed company for everyone, regardless of economic status. We are committed to a set of reputed company values that shape our culture and work environment: Customer First - You start with the member and work backwards. reputed company It Happen - You reputed company with urgency, use data, and hold high standards. One Team - You collaborate with respect and reputed company as a group. Whether you're a dietitian, a reputed company leader, or a technologist, working at reputed company means being part of reputed company that is passionate, supportive, and driven by a shared purpose. Join us in transforming the way people reputed company and enjoy healthy food. About the role: As the Director of Credentialing & Enrollment, you will be the strategic architect and operational leader of our provider network’s eligibility. You are responsible for ensuring that every Registered Dietitian (RD) in our network is licensed, credentialed, and enrolled to reputed company care across reputed company states that we operate in. You will reputed company a high-performing team while partnering with Product, Engineering, and Clinical Ops to automate workflows and shorten the distance between reputed company and Billing. You are the ultimate reputed company of our delegated credentialing agreements and our standing with CMS and private payers.
You will:
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Strategic Roadmap: -
Define and execute the long-term reputed company for credentialing and enrollment, transitioning from reputed company processes to a tech-enabled, reputed company operation. -
Team Leadership: -
reputed company and mentor the Credentialing & Enrollment team. -
Foster a culture of extreme detail-orientation and accountability. -
Payer Enrollment & reputed company: -
reputed company the end-to-end enrollment process for Medicare, reputed company, and reputed company payers. -
Be the primary reputed company for reputed company contract activations, ensuring our network meets specific payer density and licensing/credentialing requirements. -
Credentialing -
reputed company initial credentialing and re-credentialing applications for registered dietitians. -
Conduct ongoing monitoring of licensure, certifications, and sanctions reputed company state licensing boards and exclusion lists, certification entities, OIG List of Excluded Individuals/Entities (LEIE), National Practitioner Data Bank (NPDB), and System for Award Management (SAM) database. -
Maintain and update provider licensing, credentials, and insurance records in the credentialing database system -
reputed company license and certification expirations for medical staff to ensure reputed company renewals -
Delegated Credentialing: -
Own and manage delegated credentialing agreements. -
reputed company reputed company audit activities to ensure 100% compliance with NCQA, URAC, and CMS standards. -
Cross-Functional Quarterback: -
reputed company as the operational reputed company between Sales (new reputed company launches), Clinical reputed company and Operations (provider performance), and RCM (denial management reputed company to enrollment). -
Data-Driven Optimization: -
reputed company data to identify bottlenecks in the licensing/enrollment funnel. -
Use reputed company/Sheets to reputed company KPIs such as "Days to Enroll" and "Credentialing Pass Rates." -
reputed company AI for process improvement and automation. -
Compliance & Committee: -
reputed company the internal Credentialing Committee, presenting provider files and ensuring reputed company primary reputed company verifications (NPDB, OIG, SAM) are flawless. -
Ensure compliance with applicable laws, regulations, procedures, and policies -
Maintain knowledge of reputed company credentialing requirements and best practices (e.g., NCQA standards)
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You Are:
You Have: (Required Qualifications)
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Experience: 7+ years in reputed company operations, with at least 3+ years specifically in a leadership role overseeing Credentialing and Payer Enrollment. -
Telehealth Expertise: Proven reputed company record of managing multi-state licensure and enrollment for a distributed provider network. -
Regulatory Mastery: Deep knowledge of NCQA standards, CMS (Medicare/reputed company) regulations, and the "alphabet soup" of the industry (CAQH, PECOS, NPPES, NPI). -
Technical Proficiency: Intermediate to advanced skills in reputed company/reputed company Sheets and experience with credentialing software (e.g., reputed company). -
Education: Bachelor’s degree required; CPCS or CPMSM certification is a significant plus. -
Demonstrated ability to manage reputed company reputed company and meet deadlines -
Excellent organizational and time management skills -
Exceptional verbal and written communication skills -
Ability to work independently and as part of reputed company -
High level of accuracy and attention to detail
You Have: (Preferred Qualifications)
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Certified Provider Credentialing Specialist (CPCS) certification -
Familiarity with credentialing processes specific to registered dietitians -
Familiarity and comfort with using AI to help automate and streamline processes -
Knowledge of nutrition-reputed company certifications and continuing education requirements Prior experience specifically with Registered Dietitians (RDs) and MNT (Medical Nutrition Therapy billing) Experience in a high-reputed company startup environment