Credentialing Director

Job description

**This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Credentialing Director based in United States.** The Credentialing Director will provide strategic and operational leadership for a growing healthcare credentialing and provider enrollment function. This role oversees a multidisciplinary team while establishing clear performance standards, scalable processes, and departmental priorities. You will own credentialing operations across provider enrollment, credentialing, and re-credentialing, ensuring accuracy, compliance, and timely execution. The position combines people leadership, process optimization, performance management, and cross-functional collaboration. You will use operational data and key performance indicators to identify bottlenecks, improve workflows, and strengthen service quality. As the organization expands nationally, you will play a central role in scaling infrastructure, staffing, and best practices across the credentialing function. This is an opportunity to make a direct impact in a fast-paced healthcare services environment while shaping a high-performing operational team. ### Accountabilities - Lead the credentialing department, including Provider Enrollment Specialists and Credentialing Account Managers, establishing clear responsibilities, accountability structures, and performance expectations. - Define departmental strategy and objectives while aligning credentialing operations with broader organizational growth and service goals. - Coach, mentor, and develop team members, overseeing performance, workload allocation, professional development, and career progression. - Establish, monitor, and improve department-wide Key Performance Indicators (KPIs), including credentialing turnaround times, retention and turnover, network adequacy, Net Promoter Score (NPS), and error rates. - Oversee provider enrollment, credentialing, and re-credentialing activities to ensure accuracy, timeliness, regulatory requirements, and payer compliance. - Ensure accurate tracking, reporting, and documentation of enrollment status, payer communications, provider information, and credentialing activities across relevant systems. - Serve as the escalation point for complex provider, payer, enrollment, or claims-related issues that require senior-level intervention. - Maintain strong oversight of processes involving Council for Affordable Quality Healthcare (CAQH) profiles, payer applications, credentialing systems, and internal databases. - Design, implement, and continuously improve Standard Operating Procedures (SOPs), quality controls, and workflows to increase efficiency and reduce cycle times. - Analyze operational trends, performance metrics, bottlenecks, and capacity requirements to support strategic decision-making. - Lead the scaling of the credentialing function as operations expand nationally, including staffing strategies, resource planning, and process infrastructure. - Partner with client-facing credentialing leadership to ensure commitments are supported by sufficient departmental capacity and operational readiness. - Serve as a senior liaison with Revenue Cycle, Operations, Compliance, Clinical Leadership, and other cross-functional stakeholders. - Provide leadership with executive-level reporting on department performance, risks, capacity, priorities, and strategic initiatives. - Represent the credentialing function in cross-functional and leadership meetings, ensuring alignment with organizational objectives. ### **Requirements** - 7+ years of experience in provider relations, credentialing, provider enrollment, healthcare operations, or a related healthcare services field, with progressively increasing leadership responsibility. - 4+ years of people management experience, including responsibility for multiple direct reports and/or managers. - Strong understanding of medical billing, payer enrollment, claims resolution, provider credentialing, and healthcare operational workflows. - Demonstrated ability to build, lead, and develop high-performing teams while establishing accountability and performance standards. - Proven experience designing and implementing scalable processes, operational controls, and departmental best practices. - Bachelor’s degree required; a degree in healthcare administration, business, process improvement, or a related discipline is preferred. - Exceptional organizational, analytical, problem-solving, and reporting capabilities, with experience presenting operational information to senior leadership. - Strong communication and stakeholder management skills, with the ability to influence effectively across teams, functions, and organizational levels. - Proficiency with Microsoft Office Suite and credentialing, enrollment, or provider management databases. - Strong attention to detail and the ability to identify issues, evaluate risks, and make sound decisions in complex operational situations. - Ability to work effectively in a fast-paced, high-growth healthcare environment with evolving priorities and competing demands. ### **Benefits** - Annual salary range of **$100,000–$120,000 USD**. - Potential eligibility for company bonus programs in addition to base compensation. - Medical insurance. - Dental insurance. - Vision insurance. - 401(k) retirement plan. - Paid time off. - Comprehensive benefits package with additional employee benefits. - Opportunity to lead and scale a critical healthcare operations function. - High-impact leadership role with significant ownership over strategy, people, processes, and performance.