Credentialing Director

About the role

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.