Foodsmart

Director

• Define and execute the long-term vision for credentialing and enrollment, transitioning from manual processes to a tech-enabled, scalable operation.
• Lead and mentor the Credentialing & Enrollment team.
• Oversee the end-to-end enrollment process for Medicare, Medicaid, and Commercial payers.
• Be the primary liaison for enterprise contract activations, ensuring our network meets specific payer density and licensing/credentialing requirements.
• Oversee initial credentialing and re-credentialing applications for registered dietitians.
• Conduct ongoing monitoring of licensure, certifications, and sanctions via state licensing boards and exclusion lists, certification entities, OIG List of Excluded Individuals/Entities (LEIE), National Practitioner Data Bank (NPDB), and System for Award Management (SAM) database.
• Maintain and update provider licensing, credentials, and insurance records in the credentialing database system
• Track license and certification expirations for medical staff to ensure timely renewals
• Own and manage delegated credentialing agreements.
• Lead all audit activities to ensure 100% compliance with NCQA, URAC, and CMS standards.
• Act as the operational bridge between Sales (new client launches), Clinical Quality and Operations (provider performance), and RCM (denial management related to enrollment).
• Leverage data to identify bottlenecks in the licensing/enrollment funnel.
• Use Excel/Sheets to track KPIs such as "Days to Enroll" and "Credentialing Pass Rates."
• Leverage AI for process improvement and automation.
• Lead the internal Credentialing Committee, presenting provider files and ensuring all primary source verifications (NPDB, OIG, SAM) are flawless.
• Ensure compliance with applicable laws, regulations, procedures, and policies
• Maintain knowledge of current credentialing requirements and best practices (e.g., NCQA standards)

Director, Credentialing and Enrollment

Operations

• Work cross-functionally with Sales, Client Development, Member Outreach, Product, Engineering, Clinical Operations, Support, Revenue Cycle, and Analytics to ensure a smooth partner onboarding experience.
• Own client eligibility file setup, ongoing monitoring, and accuracy including file processing and issue resolution.
• Own client QA processes ensuring accuracy and on-time launches.
• Document client business requirements and serve as liaison with internal and external technical teams.
• Lead client conversations about data integrations, configuration requirements, member workflows, and benefit design during pre-sales scoping and implementation discussions.
• Identify and escalate risks to a successful implementation and delivery or ongoing partnership, pivoting to ensure bottlenecks are addressed in a timely manner.

Eligibility Operations Manager

Accounts Payable

• Support day-to-day operational accounting activities, including AR and AP.
• Partner with cross-functional teams (operations, HR, finance) to support business transactions and ensure proper accounting treatment.
• Assist with external audits, providing documentation and explanations as required.
• Identify opportunities to improve efficiency in operational accounting processes, supporting best practices and automation initiatives.
• Set up and maintain accurate customer records within the billing system.
• Generate and send accurate invoices and credit memos to customers.
• Monitor aging reports and perform proactive outreach to customers regarding overdue balances.
• Post daily deposits and reconcile them against open receivables.
• Receive, verify, and enter vendor invoices into the accounting system with correct GL coding.
• Prepare weekly check runs, ACH transfers, and wire payments.
• Act as the primary point of contact for vendor inquiries and resolve any billing discrepancies or statement disagreements.
• Review and process employee expense reimbursements, ensuring compliance with company policy and correct GL coding.

Director, Credentialing and Enrollment

Eligibility Operations Manager

AR & AP Specialist