Director, Credentialing and Enrollment

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

📋 Description

• Oversee the credentialing and payer enrollment departments.

• Establish strategic objectives, policies, and performance benchmarks.

• Act as a subject matter expert in provider credentialing, accreditation, insurance regulations, policies, guidelines, and standards.

• Build and lead a high-performing team through hiring, training, coaching, and performance management.

• Create and execute process enhancements to decrease enrollment turnaround time and address credentialing backlogs.

• Collaborate with Revenue Operations to address enrollment-related claim denials or delays.

• Manage the relationship with Eleanor’s Credentialing and Enrollment vendor.

• Serve as the primary contact for the vendor.

• Ensure the vendor meets service level agreements (SLAs) and identify opportunities to enhance the partnership.

• Develop dashboards and reports to monitor turnaround time, expirable tracking, and enrollment status.

• Report key performance metrics to leadership.

• Communicate with providers, Operations Managers, and internal stakeholders about daily credentialing and enrollment operations.

• Identify, monitor, and mitigate compliance risks, escalating issues to senior leadership when necessary.

• Stay updated on industry regulations and requirements.

• Assist with audits and regulatory reviews.

⛳️ Requirements

• 7+ years of progressive experience in credentialing and/or payer enrollment.

• A minimum of 3 years in a leadership position.

• Demonstrated ability to manage teams, establish scalable processes, and drive national operational efficiency.

• Strong analytical, organizational, and communication skills.

• Familiarity with relevant federal and state regulations.

• Knowledge of CAQH, NPPES, PECOS, and payer credentialing portals.

• In-depth understanding of NCQA and The Joint Commission (TJC) standards.

• Analytical mindset with skills in root cause analysis and process improvement.

• Capability to work with and analyze large datasets.

• Experience in developing clear and informative training/documentation materials.

• Startup experience is preferred.

• Experience with Athena is preferred.

• Background in delegated credentialing arrangements and health plan audits.

• Proven track record of successfully leading process improvement initiatives.

• Excellent analytical and problem-solving abilities.

• Collaborative and team-oriented approach.

• Ability to adapt and thrive in a dynamic environment.

🏝️ Benefits

• Generous Paid Time Off (prorated for new hires).

• 12 Vacation days.

• 12 Wellness (Sick) days.

• 3 Floating holidays.

• 9 Company-observed holidays.

• Jury Duty, Voting Leave, and other forms of paid time off may be available.

• Eleanor-covered medical and dental insurance plans.

• Affordable vision coverage.

• 401(k) plan with a 3% match.

• Short-term disability.

• Long Term Disability (employee paid).

• Life Insurance options, including both Eleanor- and employee-paid plans.

• Paid Family & Medical Leave (PFML).

• Mindfulness App Reimbursement.

• Employee Assistance Program (EAP) with eight face-to-face sessions.

• Virtual health and wellness visits covered by the medical plan.

• Remote work arrangement.