Credentialing Director

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the complete credentialing department, which includes Provider Enrollment Specialists and Credentialing Account Managers, ensuring defined roles, accountability, and performance expectations.

• Establish departmental objectives and strategies, ensuring alignment of credentialing operations with the broader goals of organizational growth.

• Coach, mentor, and nurture team members; oversee performance, workload allocation, and career advancement.

• Establish and evaluate department-wide KPIs, such as credentialing turnaround time, retention/turnover rate, network adequacy, Net Promoter Score, and error rates.

• Manage provider enrollment, credentialing, and re-credentialing activities to guarantee accuracy, timeliness, and compliance with payers.

• Ensure proper tracking, reporting, and documentation of enrollment status, payer communications, and provider data across systems.

• Act as the escalation point for complex provider, payer, or claims-related issues.

• Maintain an up-to-date knowledge of CAQH profiles, payer applications, and internal credentialing databases.

• Design, implement, and enhance department-wide processes, SOPs, and quality control measures.

• Analyze trends, bottlenecks, and performance metrics to inform strategic decision-making.

• Lead efforts to scale the credentialing function as the organization expands nationally, including staff planning and process infrastructure.

• Collaborate with the Credentialing Account Manager to support client-facing commitments and operational readiness.

• Work closely with Revenue Cycle, Operations, Compliance, and Clinical Leadership.

• Provide executive-level updates and reports on departmental performance, risks, capacity planning, and strategic initiatives.

• Represent the credentialing department in cross-functional and leadership meetings.

⛳️ Requirements

• A minimum of 7 years of experience in provider relations, credentialing, enrollment, or healthcare operations, with increasing leadership responsibilities.

• At least 4 years of experience in people management, including overseeing multiple direct reports and/or managers.

• Strong knowledge of medical billing, payer enrollment, claims resolution, and healthcare workflows.

• Demonstrated capability to build and lead teams, foster accountability, and implement scalable departmental processes.

• Bachelor's degree is required.

• A degree in healthcare administration, business, or process improvement is preferred.

• Exceptional organizational, analytical, and reporting abilities, with experience in presenting to senior leadership.

• Strong communication skills with the capacity to influence at various levels and across functions.

• Proficiency in Microsoft Office Suite and credentialing/enrollment databases.

• Ability to excel in a fast-paced, high-growth environment with shifting priorities.

• Detail-oriented with robust problem-solving and decision-making skills.

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k)

• Paid time off

• Comprehensive benefits package

• Opportunity to participate in company bonus programs for eligible employees