Director of Credentialing

• Provide strategic leadership for all credentialing, recredentialing, privileging, and provider enrollment activities. 
• Build, lead, and mentor a high-performing credentialing team with appropriate staffing, training, accountability, and performance management. 
• Develop and implement departmental goals, SOPs, KPIs, and quality assurance measures. 
• Facilitate training, ongoing education, and change management as credentialing systems and requirements evolve. 

• Oversee verification of licensure, education, training, certifications, work history, malpractice coverage, and professional references. 
• Establish proactive workflows for managing all expirable items, including license, certification, and insurance renewals. 
• Ensure accurate management of provider files, credentialing data, and documentation within credentialing software platforms. 
• Direct the privileging process in collaboration with medical leadership, department chiefs, and compliance teams. 
• Provide credentialing support for committee meetings, audits, board reviews, and documentation needs. 

• Ensure compliance with all federal, state, and local regulatory bodies including CMS, The Joint Commission, NCQA, URAC, and commercial payer standards. 
• Maintain up-to-date knowledge of regulatory changes and lead revisions to policies, procedures, and workflows accordingly. 
• Conduct and oversee internal audits to ensure readiness for accreditation surveys and external reviews. 

• Oversee timely and accurate submission of enrollment applications with Medicare, Medicaid, and commercial payers. 
• Track and manage enrollments, revalidations, payer updates, and expirables to prevent reimbursement delays or claim denials. 
• Partner with Revenue Cycle and Managed Care to resolve enrollment-related claim issues and streamline payer setup workflows. 

• Manage external credentialing and verification vendors, ensuring high performance, compliance, service quality, and contractual adherence. 
• Evaluate vendor capabilities, negotiate service agreements, monitor KPIs, and drive accountability for accuracy and turnaround times. 
• Lead transitions, implementations, or optimization projects involving outsourced credentialing or enrollment partners. 

• Continuously evaluate and enhance credentialing workflows to reduce turnaround times, improve accuracy, and support scalability. 
• Lead implementation or optimization of credentialing software, automation tools, and data-management technologies. 
• Develop and oversee dashboard reporting for KPIs, productivity, turnaround time, expirables, enrollment status, and quality metrics. 
• Collaborate with IT, Managed Care, Compliance, and Operations on cross-functional systems and technology initiatives. 

• Serve as the primary organizational contact for providers, clinical leaders, health plans, and regulatory bodies regarding credentialing matters. 
• Promote a provider-centric experience through timely communication, streamlined processes, and exceptional service standards. 
• Collaborate with HR, Legal, Compliance, Managed Care, and Clinical Operations on onboarding and cross-functional initiatives. 
• Deliver clear, concise presentations to executive leadership, including reporting on credentialing performance, risks, and mitigation strategies. 
• Prepare and present executive-ready materials including slide decks, dashboards, and credentialing summaries for operational and leadership reviews. 

• Bachelor’s degree in healthcare administration, business, or related field. 
• 7 or more years of credentialing experience in a healthcare organization, MSO, medical group, ASC, or hospital. 
• 3 or more years of leadership or management experience. 
• Strong working knowledge of CMS, Joint Commission, NCQA, URAC, and payer credentialing and enrollment requirements. 
• Proficiency with credentialing software systems, provider databases, and digital document management. 
• Experience in multi-site or multi-state healthcare delivery organizations, or MSOs. 

• Master’s degree in healthcare administration, business administration, or related field. 
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM). 
• Proficiency with CredentialStream/Verity preferred.
• Experience implementing credentialing software or leading large-scale credentialing process redesign. 

• Exceptional attention to detail and commitment to data accuracy 
• Strong analytical, organizational, and project management abilities 
• Excellent written, verbal, and presentation development skills 
• Ability to lead teams through change and build scalable credentialing infrastructure 
• High integrity, discretion, and commitment to confidentiality 
• Ability to work cross-functionally and influence without formal authority 
• Strong relationship management and customer service orientation 

This is a remote position.