Director of Credentialing & Provider Enrollment

Overview:

We offer a supportive culture that is driven by deep commitment to the success of our patients and our teams. We invest in YOU and are dedicated to creating individualized opportunities for career advancement. In addition, we invest in our employees by offering:

• Competitive compensation package
• Outstanding work life balance
• Health, vision, and dental benefits
• 401K plan match
• Life insurance (100% company paid)
• PTO and paid holidays
• We invest substantial energy and resources in building a highly-engaged culture where your voice is heard, you are connected to a community of professionals who share your values, and you can thrive.

About the role: 

The Director of Credentialing & Provider Enrollment is responsible for the strategic oversight, execution, and continuous improvement of all credentialing, recredentialing, and payer enrollment processes across a specialty physician practice. This role ensures timely provider onboarding, regulatory compliance, and optimized payer participation to support revenue cycle performance and patient access.

The Director will lead a credentialing and enrollment team, standardize workflows, and collaborate cross-functionally with Revenue Cycle, Compliance, Legal, Medical Staff, and Operations to ensure efficient provider lifecycle management.

This role also plays a critical part in minimizing revenue leakage tied to enrollment delays and credentialing errors, particularly in specialty care environments with complex payer rules and procedure-based billing.

Responsibilities:

• Direct the full lifecycle of provider credentialing including initial credentialing, recredentialing, privileging support, and terminations/deactivations
• Ensure compliance with NCQA, CMS, and state-specific requirements. And Specialty board certification and privileging standards
• Oversee primary source verification processes including licensure, DEA, board certification, education, training, malpractice history, sanctions (OIG/SAM)
• Establish and maintain credentialing timelines and SLAs (e.g., <90 days for enrollment readiness)
• Implement audit-ready credentialing files and documentation standards
• Lead all provider enrollment activities across Medicare, Medicaid, and commercial payers
• Manage complex enrollment scenarios, multi-state licensure and payer requirements.
• Oversee CAQH, PECOS, NPPES maintenance and accuracy
• Coordinate with contracting to ensure alignment between
• Maintain payer relationships to resolve enrollment issues and expedite approvals
• Design and maintain end-to-end credentialing workflows tailored for specialty practices
• Build scalable credentialing and enrollment infrastructure
• Implement automation or credentialing software tools where applicable
• Lead, mentor, and develop credentialing and enrollment staff
• Demonstrate and promote a work culture committed to UVVC's Core Values: understanding, nurturing, ingenuity, trust, excellence, and diversity.
• Demonstrate behaviors that are consistent with UVVC's Standards of Conduct as outlined in our Employee Handbook.
• Maintain the confidentiality and security of Protected Health Information (PHI) in accordance with UVVC policies, the Health Insurance Portability and Accountability Act (HIPAA), and other applicable laws and regulations. PHI is a top priority of our organization.

Qualifications:

• Bachelor's degree in Finance, Accounting, Healthcare Administration, Business or similar field preferred.
• 8-10 years of work experience in credentialing and provider enrollment, managed care, healthcare operations or related area.
• Strong industry acumen of payor business models and how innovations in healthcare will impact the future of reimbursement.
• Demonstrated experience building programs or operational processes from scratch.
• Strong analytical and communication skills.
• Dependable; able to meet reliable attendance and punctuality standards.