Credentialing Director

Credentialing Director

We are seeking an experienced and strategic Credentialing Director to lead and oversee our credentialing and provider enrollment department. Reporting to the Sr. Director, Center of Excellence, this role will be responsible for setting departmental strategy, implementing KPIs and scalable processes, and directly managing a team that includes Provider Enrollment Specialists and Credentialing Account Managers.

The Credentialing Director will own department-wide performance, establish best practices, ensure compliance, and drive continuous improvement aligned with organizational growth. This role blends people leadership, process ownership, and strategic execution in a fast-paced healthcare services environment.

What You Will Do

Departmental Leadership

• Oversee the entire credentialing department, including Provider Enrollment Specialists and Credentialing Account Managers, ensuring clear roles, accountability, and performance standards.
• Set departmental goals and strategy, aligning credentialing operations with broader organizational growth objectives.
• Coach, mentor, and develop team members; manage performance, workload distribution, and career growth.
• Establish and monitor department-wide KPIs (e.g., credentialing turnaround time, retention/turnover rate, network adequacy, Net Promoter Score, error rates) and hold the team accountable to targets.

Operational Oversight

• Oversee all provider enrollment, credentialing, and re-credentialing activities across the department to ensure accuracy, timeliness, and payer compliance.
• Ensure effective tracking, reporting, and documentation of enrollment status, payer communications, and provider data across systems.
• Serve as the escalation point for complex provider, payer, or claims-related issues that cannot be resolved at the team level.
• Maintain strong working knowledge of CAQH profiles, payer applications, and internal credentialing databases.

Process Improvement & Strategy

• Design, implement, and continuously refine department-wide processes, SOPs, and quality controls to streamline workflows and reduce cycle times.
• Analyze trends, bottlenecks, and performance metrics to inform strategic decision-making.
• Lead scaling efforts for the credentialing function as the organization expands nationally, including staffing plans and process infrastructure.
• Partner with the Credentialing Account Manager to ensure client-facing commitments are supported by department capacity and operational readiness.

Stakeholder Management

• Serve as the senior liaison with internal teams including Revenue Cycle, Operations, Compliance, and Clinical Leadership.
• Provide executive-level updates and reporting to leadership on department performance, risks, capacity planning, and strategic initiatives.
• Represent the credentialing department in cross-functional and leadership meetings, ensuring alignment with organizational priorities.

What It Takes to Join the Team

• 7+ years of experience in provider relations, credentialing, enrollment, or healthcare operations, with progressive leadership responsibility.
• 4+ years of people management experience, including managing multiple direct reports and/or managers.
• Strong understanding of medical billing, payer enrollment, claims resolution, and healthcare workflows.
• Proven ability to build and lead teams, drive accountability, and implement scalable processes at a departmental level.
• Bachelor's degree required; degree in healthcare administration, business, or process improvement preferred.
• Exceptional organizational, analytical, and reporting skills, with experience presenting to senior leadership.
• Strong communication skills with the ability to influence across levels and functions.
• Proficiency in Microsoft Office Suite and credentialing/enrollment databases.
• Ability to thrive in a fast-paced, high-growth environment with evolving priorities.
• Detail-oriented with strong problem-solving and decision-making capabilities.