Director of Credentialing
Remote · United States
Job Summary
Director of Credentialing leads and manages credentialing, privileging, provider enrollment, and payer enrollment across all clinics and care sites, ensuring regulatory, accreditation, and payer compliance while driving operational excellence. Oversees credentialing staff and vendor relationships, maintains accuracy and timeliness of credentialing data, and serves as the organization’s expert on credentialing policies, workflows, and industry standards. Key duties include strategic leadership for credentialing activities, development of SOPs and KPIs, staff training, oversight of licensure and certification verifications, provider-file management, and collaboration with compliance, regulatory bodies, and leadership; supports audits, committee meetings, and enrollment submissions; drives process improvements and technology implementations; delivers executive-ready reporting and analytics. This is a remote position.
Required Qualifications
- Bachelor’s degree in healthcare administration, business, or related field
- 7 or more years of credentialing experience in a healthcare organization, MSO, medical group, ASC, or hospital
- 3 or more years of leadership or management experience
- Strong working knowledge of CMS, Joint Commission, NCQA, URAC, and payer credentialing and enrollment requirements
- Proficiency with credentialing software systems, provider databases, and digital document management
- Experience in multi-site or multi-state healthcare delivery organizations, or MSOs
- Preferred: Master’s degree in healthcare administration, business administration, or related field
- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)
- Proficiency with CredentialStream/Verity preferred
- Experience implementing credentialing software or leading large-scale credentialing process redesign
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