Director of Credentialing

Position Summary

The Director of Credentialing provides strategic oversight of provider credentialing, payer enrollment, compliance, and onboarding operations. This role leads department performance, process standardization, AI-driven efficiencies, and initiatives that support organizational growth and scalability.

Key Responsibilities

• Oversee all provider credentialing, payer enrollment, recredentialing, and compliance activities across the organization.

• Develop and monitor credentialing KPIs, provider onboarding timelines, enrollment aging reports, and department performance metrics.

• Lead initiatives to improve provider onboarding speed, enrollment accuracy, and regulatory compliance.

• Establish standardized credentialing processes, SOPs, and quality assurance measures across all markets.

• Partner with operations, recruiting, compliance, and clinical leadership to support provider onboarding and expansion initiatives.

• Lead credentialing system improvements, vendor management, and department optimization projects.

• Serve as the strategic operational leader responsible for credentialing efficiency, scalability, and compliance.

• AI & Automation Responsibilities:

  • Implement AI-powered provider onboarding workflows to reduce credentialing turnaround times.

  • Develop automated license, certification, and recredentialing tracking systems.

  • Utilize AI to analyze enrollment bottlenecks and identify process improvement opportunities.

  • Lead adoption of automation tools that streamline payer enrollment, document management, and compliance reporting.

Requirements

• Minimum Requirements: Bachelor's degree in Healthcare Administration, Business Administration, or related field required. Minimum 7 years of credentialing and payer enrollment experience, with at least 3 years in a leadership role. Extensive knowledge of provider credentialing, payer enrollment, CAQH, recredentialing, and regulatory compliance requirements. Experience managing multi-state provider credentialing operations and onboarding programs. Proven success leading department improvements, workflow standardization, and operational scalability initiatives.

Benefits

• Health

• Dental

• Vision

• 401(k) & Match

• Paid time off