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
Related jobs
-
A/B | A/B Testing | Affiliate Marketing | Average Order Value | B testingCross-functional team collaboration | Industry domain growth impact | Remote workExecutive-level Full TimeRemote USA, United States R5h ago
-
CAQH | CVO Certification | Credentialing | Data analytics | Delegated CredentialingExecutive-level Full TimeUnited States - Remote R19h ago
-
Director & Actuary - ALM Analytics USD 175K-249KALM | Actuarial valuation | Cash Flow | Cash Flow Forecasting | Dashboards401k match | Adoption Assistance | Financial Planning Time Off | Health benefits | Holiday scheduleExecutive-level Full TimeNewport Beach CA-700, United States R1d ago
-
Director, Analytics & AI Solutions USD 160K-205KAI | Analytics Strategy | Business Intelligence | Data Governance | Data Modeling401k | Dental insurance | Medical insurance | Paid leave | Tuition reimbursementExecutive-level Full TimeUniversal City, CA, United States R4d ago
-
Director, Analytics & AI Solutions USD 160K-205KArtificial Intelligence | Business Intelligence | Data Ingestion | Data Modeling | Data analytics401k | Dental insurance | Discounts | Medical insurance | Paid leaveExecutive-level Full TimeNew York, NEW YORK, United States R5d ago
-
Executive Director, Data Governance Lead USD 120K-173KCompliance | Data Governance | Data Lineage | Data Management | Data PrivacyFlexible hybrid work model | Health and life insurance | Paid time off | Pension/retirement benefits | Personal/Family Care leavesSenior-level Full TimeJersey City, NJ, United States R6d ago
-
Director of AI Engineering USD 156K-234KAI orchestration | Branch protection | CI/CD | Deployment integrity | Evaluation Pipelines401k match | Company holidays | Dental insurance | Education reimbursement | Gym reimbursementExecutive-level Full TimeUnited States - Remote R6d ago
-
Builders Risk | Builders Risk Insurance | Business Interruption | Claims management | Construction scheduling401k matching | Dental insurance | Disability insurance | Family leave | Life insuranceExecutive-level Full TimeUnited States - Remote R7d ago
-
Director, Data Management and Analytics USD 142K-162KAnalytics Platforms | Business Intelligence | Compliance | Data Governance | Data ManagementHybrid work option | Professional development opportunitiesExecutive-level Full TimeBlacksburg, Virginia, Hybrid R8d ago
-
Director of Supply Chain Strategy and Optimization USD 142K-169KAutomation | Chain management | Change Management | Cost Reduction | Data analyticsFlexible work arrangements | Health and wellness benefits | Remote work optionExecutive-level Full TimeRemote-Michigan-LCE, United States R8d ago
-
Director - BIS Global Head of Data & Analytics USD 215K-275KAI Embeddings | Agentic Workflows | Automation | C# | Data EngineeringFlexible time off | Healthcare | Hybrid work model | Retirement benefits | Tuition reimbursementExecutive-level Full TimeNY7 - 50 Hudson Yards, New … R8d ago
-
Director, Data Governance USD 147K-184KCause analysis | Change Management | Cloud Platforms | Data Compliance | Data Governance401k company match | Adoption Assistance | Educational assistance | Flexible spending account | Health, dental, vision insuranceExecutive-level Full TimeUnited States R12d ago
-
Director Statistical Programming USD 182K-257KClinical data | Data Validation | Documentation | FDA | GCPExecutive-level Full TimeUSA-California-Remote, United States R12d ago
-
GTM Lead, Payments & Embedded Finance USD 250K-275KBusiness Development | Business case | Business case development | Case Development | Channel Strategy401k match | Flexible time off | Health benefits | Remote-friendly | Stock optionsSenior-level Full TimeUnited States (Remote) R13d ago
-
Director, Forecasting & Analytics USD 200K-300KAnalytics modeling | Business planning | Claims data | Competitive Intelligence | Cross-functional401k match | Commuter benefits | Dental insurance | Health insurance | Lifestyle spending accountExecutive-level Full TimePrinceton US Market - 777 Scudders … R13d ago
-
Director, Strategic Analytics & Content Optimization USD 130K-200KBigQuery | Data Storytelling | Data Visualization | Data analytics | Excel401k | Dental insurance | Discounts | Medical insurance | Paid leaveExecutive-level Full TimeNew York, NEW YORK, United States R15d ago
-
Change Management | Clinical data | Clinical data management | Cross-functional | Cross-functional leadershipCompetitive benefits | Remote workExecutive-level Full TimeUnited States R21d ago
-
Director HR Information Systems & Analytics USD 175K-190KAnalytics | Cause analysis | Data Governance | Data Security | Data analyticsHybrid work | Travel opportunitiesExecutive-level Full TimeUS MA Chelmsford 271, United States R21d ago
-
Sr. Director, Data Analysis - Software (Remote) USD 245K-307KAWS | Apache Flink | Apache Kafka | Apache Spark | Big DataSenior-level Full TimeUS Remote, United States R22d ago
-
Agentic Workflows | Amazon Web Services | Artificial Intelligence | Cloud platform | DBTAutonomy | Inclusive culture | Mentorship | Professional development | Remote-first work environmentSenior-level Full TimeUS-Remote R28d ago
-
Director, Process Optimization & Automation USD 125K-190KArtificial Intelligence | Automation | Business case | Business case development | Case Development401k retirement plan | Adoption Assistance | Caregiver leave | Employee assistance program | Employee discountsExecutive-level Full Time1450 American Lane, IL, 500 Woodward … R29d ago
-
Access Control | Azure Databricks | Azure Storage | Azure Well Architected | Azure Well-Architected FrameworkMid-level Full TimeCHICAGO, United States R29d ago
-
Access Control | Azure | Azure Databricks | Azure Storage | C#401k employer match | Adoption Assistance | Choice time off | FSA and HSA accounts | Hybrid work modelMid-level Full TimeMINNEAPOLIS, United States R30d ago
-
Access Control | Azure | Azure Databricks | Azure Storage | Azure Well Architected401k matching | Choice time off | Hybrid work | Medical, dental, and vision insurance | Paid HolidaysMid-level Full TimeNEW YORK CITY, United States R30d ago
-
Access Control | Azure AI | Azure Databricks | Azure Storage | CI/CDMid-level Full TimeCHICAGO, United States R30d ago