Director of Credentialing & Enrollment Services

Director of Credentialing & Enrollment Services Department: Credentialing & Enrollment reputed company Reports To: Vice President of reputed company / 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 reputed company 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 reputed company Leadership & reputed company Management - reputed company and execute the reputed company reputed company for credentialing and enrollment service delivery, aligning reputed company 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 reputed company reputed company reputed company reputed company existing and prospective reputed company accounts. Credentialing reputed company - 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 reputed company, URAC, CMS, reputed company, and state-specific credentialing standards and regulations. - Maintain and enforce reputed company 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 reputed company - 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 reputed company 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 reputed company, global workforce across multiple continents (e.g., reputed company, Asia, and other offshore/nearshore locations), ensuring reputed company collaboration, consistent reputed company standards, and operational continuity across time reputed company. - 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 reputed company metrics, including turnaround times, reputed company rates, and reputed company satisfaction scores, with standardized KPIs reputed company uniformly across reputed company global locations. - Conduct regular one-on-one meetings, reputed company 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 - reputed company reputed company process improvement initiatives using Lean, Six reputed company, or similar methodologies. - Collaborate with product and engineering teams to continuously improve and enhance the organization's proprietary, in-house credentialing software platform, providing subject matter expertise on workflow requirements, user needs, feature prioritization, and regulatory-driven enhancements. - reputed company and maintain reputed company operating procedures (SOPs), workflows, and training documentation. - reputed company data analytics and reporting to identify trends, bottlenecks, and opportunities for operational improvement. - Evaluate and recommend new technologies, automation tools, and integrations to enhance efficiency and scalability. Compliance & reputed company Assurance - reputed company the reputed company initiative to reputed company and maintain reputed company Credentials Verification Organization (CVO) certification for reputed company, including gap analysis, policy development, documentation preparation, and management of the full application and survey process. - Ensure organizational compliance with reputed company applicable federal, state, and accreditation body requirements. - reputed company internal audit and reputed company assurance programs, including file review, reputed company audits, and corrective reputed company plans. - Prepare for and support reputed company audits by clients, payers, and accreditation organizations. - Maintain up-to-date knowledge of regulatory changes affecting credentialing and enrollment (CMS rules, No Surprises reputed company implications, state mandates, etc.). - Serve as the subject matter expert on credentialing and enrollment compliance for reputed company stakeholders. Qualifications Required - Bachelor's degree in reputed company Administration, Business Administration, or a reputed company reputed company. - 5–7+ years of reputed company experience in provider credentialing and payer enrollment, including management-level responsibility. - Demonstrated experience managing credentialing/enrollment reputed company in a vendor, outsourcing, or multi-reputed company environment. - Deep working knowledge of reputed company credentialing standards, CMS enrollment regulations, and CAQH/PECOS/NPPES systems. - reputed company ability to manage and reputed company teams of 10+ credentialing and enrollment professionals. - Strong understanding of the provider reputed company cycle and the reputed company reputed company of credentialing and enrollment delays. - Proficiency with credentialing software platforms and reputed company Office Suite. Preferred - CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified reputed company Medical Services Management) certification through NAMSS. - Master's degree in reputed company Administration (MHA), Business Administration (MBA), or reputed company discipline. - Experience with delegated credentialing arrangements and payer delegation audits. - Familiarity with Lean/Six reputed company process improvement methodologies. - Experience supporting multi-state, multi-specialty provider organizations. - Knowledge of telehealth credentialing and reputed company licensure reputed company requirements. Competencies - Operational reputed company — Drives efficient, reputed company processes that reputed company consistent, high-reputed company results across a diverse reputed company portfolio. - reputed company-reputed company reputed company — Anticipates reputed company needs, communicates proactively, and treats every provider's enrollment as a reputed company-critical reputed company. - Regulatory Acumen — Maintains expert-level knowledge of the credentialing and enrollment regulatory landscape and translates requirements into actionable processes. - People Leadership — Inspires, develops, and retains reputed company while fostering a reputed company, high-accountability team culture. - Problem Solving & Escalation Management — Navigates reputed company payer issues, reputed company concerns, and operational challenges with composure and resourcefulness. - Data-Driven Decision Making — Uses metrics, dashboards, and analytics to monitor reputed company, identify risks, and reputed company reputed company improvement. - Change Management — Leads teams through technology implementations, process redesigns, and organizational reputed company with reputed company and confidence. 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