Director, Credentialing and Enrollment

• Define and execute the strategic roadmap for credentialing and enrollment transitioning to a tech-enabled operation.
• Lead and mentor the Credentialing & Enrollment team fostering detail-orientation and accountability.
• Oversee end-to-end enrollment process for Medicare, Medicaid, and Commercial payers.
• Act as primary liaison for contract activations meeting payer density and requirements.
• Oversee initial and re-credentialing applications for registered dietitians.
• Conduct ongoing monitoring of licensure, certifications via relevant databases.
• Maintain and update provider records in the credentialing database.
• Track license and certification expirations ensuring renewals.
• Manage delegated credentialing agreements ensuring compliance with standards.
• Lead audit activities ensuring compliance with NCQA, URAC, and CMS standards.
• Act as operational bridge between Sales, Clinical Quality, and RCM.
• Leverage data to identify bottlenecks and optimize processes using AI.
• Lead internal Credentialing Committee ensuring flawless provider verifications.
• Ensure compliance with applicable laws and regulations.

• 7+ years in healthcare operations with 3+ years in a leadership role overseeing Credentialing and Payer Enrollment.
• Proven track record in managing multi-state licensure and enrollment for a provider network.
• Deep knowledge of NCQA standards, CMS regulations, and industry requirements.
• Intermediate to advanced skills in Excel/Google Sheets and credentialing software.
• Bachelor’s degree required; CPCS or CPMSM certification preferred.
• Certified Provider Credentialing Specialist (CPCS) certification is a plus.
• Familiarity with credentialing processes specific to registered dietitians.
• Comfort with using AI to automate processes.
• Knowledge of nutrition-related certifications and continuing education requirements.
• Experience with Registered Dietitians and MNT billing.
• Experience in a high-growth startup environment.

Pay range: $140K - $150K

• Remote-First Company
• Flexible Unlimited PTO
• Healthcare Coverage (Medical, Dental, Vision)
• 401k and FSA