Director - Credentialing & Enrollment Services
United States - Remote
R
USD 130K-165K (estimate) Executive-level Full Time
Tasks
- Achieve NCQA CVO certification
- Collaborate on credentialing software enhancements
- Develop SOPs and workflows
- Develop credentialing enrollment strategy
- Drive process improvement using Lean and Six Sigma
- Ensure credentialing compliance
- Escalate client concerns
- Lead client onboarding and enrollment planning
- Lead internal audits and quality assurance
- Leverage data analytics for reporting
- Maintain primary source verification protocols
- Manage expirables tracking and renewals
- Manage global distributed workforce
- Manage provider roster updates
- Monitor regulatory changes
- Oversee payer enrollment operations
- Oversee payer enrollment submissions
- Oversee provider credentialing lifecycle
- Prepare credentialing committee documentation
- Recruit and train credentialing teams
- Resolve enrollment denials and delays
- Set team performance metrics
- Support external audits
Perks/Benefits
- N/A
Skills/Tech-stack
CAQH | CAQH Proview | CMS | CVO Certification | Credentialing | DEA | DEA CDS | Data analytics | Delegated Credentialing | Internal Audit | Joint Commission) | Lean | Microsoft Office | NCQA | NPPES) | OIG Exclusion Monitoring | PECOS | Payer enrollment | Primary Source Verification | Process Improvement | Quality Assurance | Regulatory Compliance | SAM Exclusion Monitoring | SOP Development | Six Sigma | Source verification | State Medicaid | URAC | Workflow design
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