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Foodsmart was founded in 2010 as Zipongo to offer "eating well made simple." As an employer, Foodsmart considers its team's health and happiness central to its success, and the com
Director, Credentialing and Enrollment
Location
United States
Posted
76 days ago
Salary
$140K - $150K / year
Seniority
Lead
Job Description
Director, Credentialing and Enrollment
Foodsmart
• Define and execute the long-term vision for credentialing and enrollment, transitioning from manual processes to a tech-enabled, scalable operation. • Lead and mentor the Credentialing & Enrollment team. • Oversee the end-to-end enrollment process for Medicare, Medicaid, and Commercial payers. • Be the primary liaison for enterprise contract activations, ensuring our network meets specific payer density and licensing/credentialing requirements. • Oversee initial credentialing and re-credentialing applications for registered dietitians. • Conduct ongoing monitoring of licensure, certifications, and sanctions via state licensing boards and exclusion lists, certification entities, OIG List of Excluded Individuals/Entities (LEIE), National Practitioner Data Bank (NPDB), and System for Award Management (SAM) database. • Maintain and update provider licensing, credentials, and insurance records in the credentialing database system • Track license and certification expirations for medical staff to ensure timely renewals • Own and manage delegated credentialing agreements. • Lead all audit activities to ensure 100% compliance with NCQA, URAC, and CMS standards. • Act as the operational bridge between Sales (new client launches), Clinical Quality and Operations (provider performance), and RCM (denial management related to enrollment). • Leverage data to identify bottlenecks in the licensing/enrollment funnel. • Use Excel/Sheets to track KPIs such as "Days to Enroll" and "Credentialing Pass Rates." • Leverage AI for process improvement and automation. • Lead the internal Credentialing Committee, presenting provider files and ensuring all primary source verifications (NPDB, OIG, SAM) are flawless. • Ensure compliance with applicable laws, regulations, procedures, and policies • Maintain knowledge of current credentialing requirements and best practices (e.g., NCQA standards)
Job Requirements
- 7+ years in healthcare operations, with at least 3+ years specifically in a leadership role overseeing Credentialing and Payer Enrollment.
- Proven track record of managing multi-state licensure and enrollment for a distributed provider network.
- Deep knowledge of NCQA standards, CMS (Medicare/Medicaid) regulations, and the "alphabet soup" of the industry (CAQH, PECOS, NPPES, NPI).
- Intermediate to advanced skills in Excel/Google Sheets 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 and meet deadlines
- Excellent organizational and time management skills
- Exceptional verbal and written communication skills
- Ability to work independently and as part of a team
- High level of accuracy and attention to detail
Benefits
- Remote-First Company
- Flexible Unlimited PTO
- Healthcare Coverage (Medical, Dental, Vision)
- 401k and FSA
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