Director, Credentialing and Enrollment
Tasks
- Automate workflows with AI
- Conduct credentialing audits for compliance
- Define credentialing and enrollment strategy
- Ensure compliance with CMS regulations
- Ensure compliance with NCQA standards
- Lead credentialing and enrollment team
- Maintain provider licensing and credential records
- Manage delegated credentialing agreements
- Monitor provider licensure certifications and sanctions
- Optimize licensing and enrollment funnel using data
- Oversee payer enrollment process
- Perform primary source verifications
- Present provider files to credentialing committee
- Track license and certification expirations
- Troubleshoot multi state provider enrollment
Perks/Benefits
Skills/Tech-stack
AI | CAQH | CMS | Credentialing | Data Analysis | Delegated Credentialing | Excel | Google Sheets | KPI Tracking | Medallion | Medicaid | Medicare | NCQA | NPI | NPPES) | PECOS | Payer enrollment | Primary Source Verification | Process Automation | Source verification
Education
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