Neolytix

Optimizing Healthcare Organizations through Revenue & Cost Transformation #digitalhealth #medicalbilling #rpm #rcm #ccm

Director – Credentialing & Enrollment Services

DirectorDirectorFull TimeRemoteTeam 51-200H1B No SponsorCompany SiteLinkedIn

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

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