Foodsmart

Director, Credentialing and Enrollment

Foodsmart

full-time

Posted on:

Location Type: Remote

Location: United States

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Salary

💰 $140,000 - $150,000 per year

Job Level

Lead

About the role

  • 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)

Requirements

  • 7+ years in healthcare operations, with at least 3+ years specifically in a leadership role overseeing Credentialing and Payer Enrollment.
  • Proven track record of managing multi-state licensure and enrollment for a distributed provider network.
  • Deep knowledge of NCQA standards, CMS (Medicare/Medicaid) regulations, and the "alphabet soup" of the industry (CAQH, PECOS, NPPES, NPI).
  • Intermediate to advanced skills in Excel/Google Sheets and experience with credentialing software (e.g., Medallion).
  • Bachelor’s degree required; CPCS or CPMSM certification is a significant plus.
  • Demonstrated ability to manage complex projects and meet deadlines
  • Excellent organizational and time management skills
  • Exceptional verbal and written communication skills
  • Ability to work independently and as part of a team
  • High level of accuracy and attention to detail
Benefits
  • Remote-First Company
  • Flexible Unlimited PTO
  • Healthcare Coverage (Medical, Dental, Vision)
  • 401k and FSA
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
credentialingenrollmentdata analysisproject managementprocess improvementautomationKPI trackinglicensure managementcompliance auditingprovider performance monitoring
Soft Skills
leadershipmentoringorganizational skillstime managementcommunicationattention to detailindependenceteam collaborationproblem-solvingadaptability
Certifications
CPCSCPMSM