Director of Credentialing - Business Process Management

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

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.

• 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.

• 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.

• 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.

• 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 regular one-on-one meetings, performance reviews, and professional development planning, adapting leadership approaches to the cultural and regulatory context of each region.
• Foster a culture of accountability, continuous improvement, and operational excellence across all sites.
• Manage staffing levels and workload distribution across onshore, nearshore, and offshore teams to meet client SLAs and contractual obligations while optimizing cost efficiency.

• Drive continuous process improvement initiatives using Lean, Six Sigma, or similar…