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Director, Credentialing and Enrollment

10 hours, 16 minutes ago
United States
Full-time
Executive
Operations Manager
Project and Program Management
Apply Now
Foodsmart

Foodsmart

Foodsmart offers a personalized telehealth nutrition solution that connects members with a vast network of registered dietitians, providing tailored nutrition guidance to improve health from the comfort of home.

Health Care Providers & Services
51-250
Founded 2010
$105M raised
View All Jobs

Description

  • Define and execute the long-term vision and roadmap for credentialing and payer enrollment, moving from manual processes to a tech-enabled, scalable operation.
  • Lead, mentor, and manage the Credentialing & Enrollment team, fostering detail-orientation, accountability, and high performance.
  • Oversee end-to-end payer enrollment for Medicare, Medicaid, and commercial payers and act as primary liaison for enterprise contract activations and payer-specific requirements.
  • Manage initial credentialing and re-credentialing applications for Registered Dietitians and maintain ongoing monitoring of licensure, certifications, and sanctions.
  • Maintain and update provider licensing, credential, and insurance records in the credentialing database and track expirations to ensure timely renewals.
  • Own and manage delegated credentialing agreements and lead audit activities to maintain 100% compliance with NCQA, URAC, and CMS standards.
  • Chair and lead the internal Credentialing Committee, presenting provider files and ensuring primary source verifications (NPDB, OIG, SAM) are complete and accurate.
  • Act as the cross-functional operational bridge between Sales (client launches), Clinical Quality and Operations (provider performance), and RCM (denial management related to enrollment).
  • Use data to identify bottlenecks and optimize the licensing/enrollment funnel, track KPIs such as Days to Enroll and Credentialing Pass Rates, and leverage AI for process improvement and automation.
  • Maintain up-to-date knowledge of credentialing requirements and best practices and ensure compliance with applicable laws, regulations, and internal policies.

Requirements

  • 7+ years in healthcare operations with at least 3+ years in a leadership role overseeing Credentialing and Payer Enrollment.
  • Proven experience managing multi-state licensure and enrollment for a distributed telehealth provider network.
  • Deep knowledge of NCQA standards and CMS (Medicare/Medicaid) regulations, and familiarity with CAQH, PECOS, NPPES, and NPI.
  • Intermediate to advanced Excel/Google Sheets skills and experience with credentialing software (e.g., Medallion).
  • Bachelor’s degree required; CPCS or CPMSM certification is a significant plus.
  • Demonstrated ability to manage complex projects, meet deadlines, and maintain exceptional organizational and time-management skills.
  • High level of accuracy and attention to detail with strong verbal and written communication skills.
  • Experience conducting primary source verifications and working with exclusion lists/databases (OIG LEIE, NPDB, SAM).
  • Comfort using AI tools to support automation and process improvements (preferred).
  • Preferred: CPCS certification; familiarity with credentialing processes specific to Registered Dietitians and MNT billing; prior experience in a high-growth startup environment.

Benefits

  • Base salary $140,000–$150,000 per year.
  • $15,000 annual performance-based bonus.
  • Remote-first work environment (fully remote, US).
  • Flexible unlimited PTO.
  • Healthcare coverage: medical, dental, and vision.
  • 401(k) plan and Flexible Spending Account (FSA).
  • Company commitment to equal opportunity employment and use of AI tools to assist hiring (human decisions final).

Interested in this position?

Apply directly on the company website

Apply Now

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