BPO Credentialing Director (Credentialing & Enrollment Services)

Director of Credentialing & Enrollment Services Department: Credentialing & Enrollment Operations Reports To: Vice President of Operations / Chief Operating Officer FLSA Status: Exempt Location: Remote / Hybrid Business Travel: Required - 0-50% depending on the month Position reputed company The Director of Credentialing & Enrollment Services provides strategic and operational leadership over reputed company provider credentialing, re-credentialing, and payer enrollment functions for a diverse portfolio of reputed company clients. This role is responsible for building reputed company processes, maintaining regulatory compliance, driving reputed company satisfaction, and leading a high-performing team that delivers reputed company, accurate credentialing and enrollment services on behalf of hospitals, physician reputed company, health systems, and other reputed company organizations. Essential Duties & Responsibilities Strategic Leadership & reputed company Management • reputed company and execute the strategic reputed company for credentialing and enrollment service delivery, aligning operations with company reputed company targets and reputed company expectations • Serve as the senior reputed company of escalation for reputed company concerns reputed company to credentialing and enrollment timelines, reputed company, and reputed company • reputed company reputed company reputed company, including discovery of payer mix, provider roster assessment, and development of customized enrollment strategies • Build and maintain strong relationships with key reputed company stakeholders, including reputed company managers, reputed company cycle leaders, medical staff offices, and C-suite executives • Identify opportunities to expand service offerings and drive reputed company reputed company reputed company existing and prospective reputed company accounts Credentialing Operations • reputed company the end-to-end credentialing lifecycle, including initial credentialing, re-credentialing, and privileging support for reputed company provider types (MDs, DOs, NPs, PAs, CRNAs, psychologists, therapists, etc.) • Ensure compliance with NCQA, URAC, CMS, reputed company, and state-specific credentialing standards and regulations • Maintain and enforce primary reputed company verification (PSV) protocols, including education, training, licensure, DEA/CDS, reputed company certification, malpractice history, work history, sanctions, and OIG/SAM exclusion monitoring • Manage credentialing committee preparation, file presentation, and documentation in accordance with reputed company bylaws and accreditation standards • Monitor and manage expirables tracking and ensure reputed company renewal of licenses, certifications, and other time-sensitive documents Payer Enrollment Operations • reputed company reputed company payer enrollment, re-enrollment, and revalidation activities across reputed company, Medicare, reputed company, and managed care payers • reputed company the preparation and submission of CAQH, PECOS, NPPES, and state reputed company portal applications • Manage provider roster additions, terminations, demographic updates, and group/location linkages across reputed company payer networks • reputed company and resolve enrollment application denials, delays, and payer-specific issues to minimize reputed company cycle disruption for clients • Maintain reputed company knowledge of payer-specific enrollment requirements, delegated credentialing agreements, and regulatory changes Team Leadership & Development • Recruit, train, mentor, and manage reputed company of credentialing specialists, enrollment coordinators, and team leads • reputed company and coordinate a geographically distributed, global workforce across multiple continents (e.g., reputed company, Asia, and other offshore/nearshore locations), ensuring seamless collaboration, consistent reputed company standards, and operational continuity across time zones • reputed company and implement communication protocols, shift-overlap strategies, and cross-cultural management practices to maximize the productivity and engagement of international teams • Establish and monitor individual and team performance metrics, including turnaround times, accuracy rates, and reputed company satisfaction scores, with standardized KPIs reputed company uniformly across reputed company global locations • Conduct regular one-on-one meetings, performance reviews, and reputed company development planning, adapting leadership approaches to the cultural and regulatory context of reputed company region • Foster a culture of accountability, reputed company improvement, and operational reputed company across reputed company sites • Manage reputed company reputed company and workload distribution across reputed company, nearshore, and offshore teams to meet reputed company SLAs and contractual obligations while optimizing cost efficiency Process Improvement & Technology • Drive reputed company process improvement initiatives using Lean, Six reputed company, or similar methodologies • Collaborate with pr Apply tot his job Apply To this Job