Director of Credentialing - Business Process Management

About this role

Director of Credentialing & Enrollment Services Department: Credentialing & Enrollment Operations Reports To: Vice President of Operations / Chief Operating Officer FLSA Status: Exempt Location: Remote / Hybrid Business Travel: Required - 0-50% depending on the month --- Position Summary The Director of Credentialing & Enrollment Services provides strategic and operational leadership over all provider credentialing, re-credentialing, and payer enrollment functions for a diverse portfolio of healthcare clients. This role is responsible for building scalable processes, maintaining regulatory compliance, driving client satisfaction, and leading a high-performing team that delivers timely, accurate credentialing and enrollment services on behalf of hospitals, physician groups, health systems, and other healthcare organizations. --- Essential Duties & Responsibilities Strategic Leadership & Client Management · Develop and execute the strategic vision for credentialing and enrollment service delivery, aligning operations with company growth targets and client expectations. · Serve as the senior point of escalation for client concerns related to credentialing and enrollment timelines, quality, and outcomes. · Lead client onboarding, including discovery of payer mix, provider roster assessment, and development of customized enrollment strategies. · Build and maintain strong relationships with key client stakeholders, including practice managers, revenue cycle leaders, medical staff offices, and C-suite executives. · Identify opportunities to expand service offerings and drive revenue growth within existing and prospective client accounts. Credentialing Operations · Oversee the end-to-end credentialing lifecycle, including initial credentialing, re-credentialing, and privileging support for all provider types (MDs, DOs, NPs, PAs, CRNAs, psychologists, therapists, etc.). · Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state-specific credentialing standards and regulations. · Maintain and enforce primary source verification (PSV) protocols, including education, training, licensure, DEA/CDS, board certification, malpractice history, work history, sanctions, and OIG/SAM exclusion monitoring. · Manage credentialing committee preparation, file presentation, and documentation in accordance with client bylaws and accreditation standards. · Monitor and manage expirables tracking and ensure timely renewal of licenses, certifications, and other time-sensitive documents. Payer Enrollment Operations · Direct all payer enrollment, re-enrollment, and revalidation activities across commercial, Medicare, Medicaid, and managed care payers. · Oversee the preparation and submission of CAQH, PECOS, NPPES, and state Medicaid portal applications. · Manage provider roster additions, terminations, demographic updates, and group/location linkages across all payer networks. · Track and resolve enrollment application denials, delays, and payer-specific issues to minimize revenue cycle disruption for clients. · Maintain current knowledge of payer-specific enrollment requirements, delegated credentialing agreements, and regulatory changes. Team Leadership & Development · Recruit, train, mentor, and manage a team of credentialing specialists, enrollment coordinators, and team leads. · Lead and coordinate a geographically distributed, global workforce across multiple continents (e.g., North America, Asia, and other offshore/nearshore locations), ensuring seamless collaboration, consistent quality standards, and operational continuity across time zones. · Develop and implement communication protocols, shift-overlap strategies, and cross-cultural management practices to maximize the productivity and engagement of international teams. · Establish and monitor individual and team performance metrics, including turnaround times, accuracy rates, and client satisfaction scores, with standardized KPIs applied uniformly across all global locations. · Conduct re