Neolytix
Optimizing Healthcare Organizations through Revenue & Cost Transformation #digitalhealth #medicalbilling #rpm #rcm #ccm
Director – Credentialing & Enrollment Services
Location
United States
Posted
30 days ago
Salary
Not specified
Bachelor Degree5 yrs expEnglish
Job Description
• Provide strategic and operational leadership over all provider credentialing, re-credentialing, and payer enrollment functions for healthcare clients.
• Develop and execute the strategic vision for credentialing and enrollment service delivery.
• Serve as the senior point of escalation for client concerns related to credentialing and enrollment timelines, quality, and outcomes.
• Lead client onboarding and development of customized enrollment strategies.
• Build and maintain strong relationships with key client stakeholders.
• Oversee the end-to-end credentialing lifecycle and ensure compliance with credentialing standards and regulations.
• Direct all payer enrollment activities across commercial, Medicare, Medicaid, and managed care payers.
• Recruit, train, mentor, and manage a team of credentialing specialists and enrollment coordinators.
• Drive continuous process improvement initiatives and evaluate new technologies to enhance efficiency.
Job Requirements
- Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
- 5–7+ years of progressive experience in provider credentialing and payer enrollment, including management-level responsibility.
- Demonstrated experience managing credentialing/enrollment operations in a vendor, outsourcing, or multi-client environment.
- Deep working knowledge of NCQA credentialing standards, CMS enrollment regulations, and CAQH/PECOS/NPPES systems.
- Proven ability to manage and develop teams of 10+ credentialing and enrollment professionals.
- Strong understanding of the provider revenue cycle and the downstream impact of credentialing and enrollment delays.
- Proficiency with credentialing software platforms and Microsoft Office Suite.
- CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) certification through NAMSS preferred.
- Master's degree in Healthcare Administration (MHA), Business Administration (MBA), or related discipline preferred.
- Experience with delegated credentialing arrangements and payer delegation audits preferred.
- Familiarity with Lean/Six Sigma process improvement methodologies preferred.
- Experience supporting multi-state, multi-specialty provider organizations preferred.
- Knowledge of telehealth credentialing and interstate licensure compact requirements preferred.
Benefits
- Business Travel: Required
Related Guides
Related Categories
Related Job Pages
More Director Jobs
Director30 days ago
Full TimeRemoteTeam 51-200H1B No Sponsor
Insights Director providing disease area expertise in market research and client interactions
Pennsylvania
Director, Customs, Global Trade
LeidosLeidos is an innovation company rapidly addressing the world’s most vexing challenges in national security and health.
Director30 days ago
Full TimeRemoteTeam 10,001+Since 1969H1B Sponsor
Director of Customs leading global trade compliance strategy for Leidos
Director30 days ago
Full TimeRemoteTeam 10,001+Since 1892H1B Sponsor
Executive Director Strategy leading high-impact strategic engagement across the enterprise
Director30 days ago
Full TimeRemoteTeam 10,001+Since 1892H1B Sponsor
Senior leader shaping the clinical voice of GE HealthCare Imaging