Provide strategic and operational leadership over provider credentialing, re-credentialing, and payer enrollment functions for diverse healthcare clients.
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.
Oversee the end-to-end credentialing lifecycle, including initial credentialing, re-credentialing, and privileging support for all provider types.
Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state-specific credentialing standards and regulations.
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.
Recruit, train, mentor, and manage a team of credentialing specialists and enrollment coordinators.
Drive continuous process improvement initiatives using Lean, Six Sigma, or similar methodologies.
Lead the strategic initiative to achieve and maintain NCQA Credentials Verification Organization (CVO) certification for the company.

Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
5–7+ years of progressive experience in provider credentialing and payer enrollment, including management-level responsibility.
Demonstrated experience managing credentialing/enrollment operations in a vendor, outsourcing, or multi-client environment.
Deep working knowledge of NCQA credentialing standards, CMS enrollment regulations, and CAQH/PECOS/NPPES systems.
Proven ability to manage and develop teams of 10+ credentialing and enrollment professionals.
Strong understanding of the provider revenue cycle and the downstream impact of credentialing and enrollment delays.
Proficiency with credentialing software platforms and Microsoft Office Suite.
CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) certification through NAMSS (preferred).
Master's degree in Healthcare Administration (MHA), Business Administration (MBA), or related discipline (preferred).
Experience with delegated credentialing arrangements and payer delegation audits (preferred).
Familiarity with Lean/Six Sigma process improvement methodologies (preferred).
Experience supporting multi-state, multi-specialty provider organizations (preferred).
Knowledge of telehealth credentialing and interstate licensure compact requirements (preferred).

BPO Credentialing Director – Credentialing, Enrollment Services

Key skills