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BPO Credentialing Director – Credentialing, Enrollment Services
NeolytixDirector of Credentialing & Enrollment Services leading credentialing and payer enrollment functions for healthcare clients. Responsible for operational leadership, compliance, and team management in a remote setup.
About the role
Key responsibilities & impact- 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.
Requirements
What you’ll need- 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).
Benefits
Comp & perks- Business Travel: Required - 0-50% depending on the month
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
provider credentialingpayer enrollmentre-credentialingprivileging supportcompliance with NCQAcompliance with CMSLean methodologySix Sigmacredentialing software platformsprovider revenue cycle
Soft Skills
strategic leadershipoperational leadershipteam managementmentoringprocess improvementclient relationship managementproblem-solvingcommunicationtrainingescalation management
Certifications
CPCSCPMSM