Director, Credentialing and Enrollment

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director, Credentialing and Enrollment based in United States.

This is a strategic leadership opportunity overseeing provider credentialing, privileging, and payer enrollment operations across a growing healthcare organization.
The role is responsible for ensuring providers are credentialed and enrolled accurately, efficiently, and in compliance with regulatory and accreditation standards.
You will lead teams, establish performance expectations, and build scalable processes that reduce delays and credentialing backlogs.
The position combines operational leadership with hands-on expertise in healthcare regulations, payer requirements, and credentialing systems.
You will partner closely with Revenue Operations, clinical and operational leaders, providers, and external vendors to resolve issues and maintain continuity of care and reimbursement.
A strong focus on analytics, process improvement, compliance, and vendor performance will be essential to the role’s success.
This is an opportunity to shape credentialing and enrollment infrastructure at scale while contributing directly to efficient healthcare delivery.

Accountabilities

• Lead the credentialing and payer enrollment functions, establishing strategic objectives, policies, workflows, service standards, and performance expectations.
• Serve as the subject matter expert on provider credentialing, accreditation, payer enrollment, insurance regulations, policies, and applicable industry standards.
• Build, develop, and manage a high-performing team through hiring, onboarding, training, coaching, and performance management.
• Design and implement scalable process improvements that reduce turnaround times, eliminate backlogs, and strengthen operational efficiency.
• Partner with Revenue Operations to investigate and resolve enrollment-related claim denials, payment delays, and other revenue cycle issues.
• Manage the relationship with the external credentialing and enrollment vendor, serving as the primary point of contact and monitoring performance against agreed service levels.
• Develop dashboards, reports, and performance metrics covering turnaround times, credential expirations, enrollment status, backlogs, and other key operational indicators.
• Communicate effectively with providers, operations leaders, and internal stakeholders regarding credentialing and enrollment processes, requirements, and issues.
• Identify, monitor, and mitigate compliance risks, escalating significant concerns to senior leadership when appropriate.
• Monitor changes in federal and state regulations and accreditation requirements to maintain ongoing compliance.
• Support internal and external audits, regulatory reviews, and accreditation activities by preparing documentation and coordinating responses.
• Lead or support cross-functional initiatives focused on improving credentialing, enrollment, documentation, training, and operational performance.

Requirements

• 7+ years of progressive experience in healthcare credentialing and/or payer enrollment, including at least 3 years in a leadership or people-management capacity.
• Demonstrated ability to manage teams, develop scalable operational processes, and improve efficiency across a national or multi-site healthcare environment.
• Strong knowledge of federal and state credentialing, enrollment, accreditation, and healthcare regulatory requirements.
• Hands-on experience with CAQH, NPPES, PECOS, and payer credentialing and enrollment portals.
• Strong understanding of NCQA and The Joint Commission standards and their application to provider credentialing and compliance.
• Excellent analytical, organizational, communication, and problem-solving skills, with the ability to work with and interpret large amounts of operational data.
• Demonstrated ability to conduct root-cause analysis, identify operational gaps, and translate findings into effective process improvements.
• Experience developing clear training materials, standard operating procedures, documentation, and internal resources.
• Strong vendor-management skills, including the ability to establish expectations, monitor SLAs, identify performance gaps, and strengthen external partnerships.
• Collaborative and team-oriented approach, with the ability to work effectively across clinical, operational, financial, and administrative functions.
• Adaptability and comfort operating in a fast-paced, evolving healthcare environment.
• Startup or high-growth healthcare experience is preferred.
• Experience with Athena and delegated credentialing arrangements is preferred.
• Experience supporting health plan audits and leading credentialing or enrollment process improvement initiatives is advantageous.

Benefits

• Target compensation range of $140,000–$160,000 , with actual compensation based on qualifications, experience, skills, education, certifications, and geographic location.
• Remote position based in the  United States .
• Generous paid time off, including 12 vacation days, 12 wellness/sick days, 3 floating holidays, and 9 company-observed holidays .
• Additional paid leave may be available for jury duty, voting, and other qualifying circumstances.
• Employer-paid medical and dental insurance, with affordable vision coverage.
• 401(k) plan with a 3% employer match .
• Employer-paid short-term disability coverage and long-term disability options.
• Life insurance with both employer- and employee-paid options.
• Paid Family & Medical Leave for qualifying family and medical circumstances.
• Wellness benefits designed to support mental and physical health.
• Mindfulness app reimbursement.
• Employee Assistance Program with up to eight face-to-face sessions.
• Virtual health and wellness visits covered through the medical plan.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.