Provide strategic and operational leadership over all provider credentialing, re-credentialing, and payer enrollment functions.
Develop and execute the strategic vision for credentialing and enrollment service delivery.
Serve as the senior point of escalation for client concerns.
Lead client onboarding, including discovery of payer mix and provider roster assessment.
Oversee the end-to-end credentialing lifecycle.
Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state-specific standards.
Direct all payer enrollment, re-enrollment, and revalidation activities.
Recruit, train, mentor, and manage a team of credentialing specialists.

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.

Director of Credentialing – Business Process Management

Key skills