Position Details

Salary $140K – $150K USD / year

Type Contract

Experience lead

Exp. Years 7+ years in healthcare operations

Education Bachelor’s degree required

Category Healthcare & Medical

About this role

Director of Credentialing & Enrollment responsible for ensuring licensure, credentialing, and enrollment for all providers across states, coordinating with CMS and private payers, and leveraging tech-enabled workflows to shorten the hire-to-enroll cycle.

Key Responsibilities

Strategic roadmap for credentialing & enrollment
End-to-end payer enrollment for Medicare/Medicaid/Commercial
Oversee delegated credentialing and audits (NCQA/URAC/CMS)
Cross-functional collaboration with Sales, Clinical Ops, and RCM
Data-driven optimization of licensing/enrollment funnel

Technical Overview

Operational leadership with Excel/Sheets proficiency and credentialing software (Medallion). Deep regulatory knowledge of NCQA, CMS, CAQH, PECOS, NPPES/NPI; ongoing monitoring of licensure, certifications, and sanctions.

Ideal Candidate

The ideal candidate is a director-level credentialing and enrollment leader with 7+ years in healthcare operations and telehealth, strong NCQA/CMS knowledge, and experience with multi-state licensure; capable of automating workflows and managing delegated credentialing agreements.

Must-Have Skills

7+ years in healthcare operations with at least 3+ years in leadership overseeing Credentialing and Payer EnrollmentTelehealth multi-state licensure and enrollmentDeep knowledge of NCQA standardsCMS (Medicare/Medicaid) regulationsand CAQH/PECOS/NPPES/NPIExcel/Google Sheets and credentialing software (e.g.Medallion)Bachelor’s degree; CPCS or CPMSM certification is a significant plus

Nice-to-Have Skills

CPCS certificationFamiliarity with RD credentialingAI tools for process automationNutrition-related certifications and continuing education requirementsExperience with Registered Dietitians (RDs) and MNT billing

Tools & Platforms

MedallionExcelGoogle SheetsPECOSCAQHNPPESNPINPDBOIGLEIESAMNCQAURACCMS

Required Skills

7+ years in healthcare operations with leadership in Credentialing and Payer Enrollmenttelehealth multi-state licensureCAQHPECOSNPPESNPINCQACMSOIG/LEIE/NPDB/SAMMedallionExcel/Google Sheets

Hard Skills

CredentialingEnrollmentProvider networkMulti-state licensureTelehealthCAQHPECOSNPPESNPICMSNCQAURACOIGLEIENPDBSAMMedallionExcelGoogle SheetsDays to EnrollCredentialing Pass Rates

Soft Skills

Strategic leadershipDetail orientationCommunicationProblem solvingTime management

Certifications

Preferred

CPCSCPMSM

Industry & Role

Industry Healthcare & Medical

Job Function Lead credentialing and enrollment operations for a nationwide telehealth provider network

Role Subtype Executive & General Management

Keywords for Your Resume

credentialingenrollmentprovider networktelehealthmulti-state licensurecaqhpecosnppesnpicmsncqauracoigleienpdbsammedallionexcelgoogle sheetsdays to enrollcredentialing pass ratesCAQHPECOSNPPESNPICMS

Deal Breakers

7+ years in healthcare ops with leadership in credentialing, Telehealth multi-state licensure experience, Bachelor’s degree required

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Director, Credentialing and Enrollment

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