Director Of Credentialing - Business Process Management
Neolytix LLC
Chicago, IL, United States
On-site
Provider credentialing and re-credentialing management
Payer enrollment and caqh pecos systems
Ncqa urac cms regulatory compliance
The Director provides strategic leadership over provider credentialing, re-credentialing, and payer enrollment functions for a diverse portfolio of healthcare clients
Job Summary
The Director provides strategic leadership over provider credentialing, re-credentialing, and payer enrollment functions for a diverse portfolio of healthcare clients.
This role requires managing a geographically distributed global workforce while ensuring seamless collaboration and consistent quality standards across multiple continents.
The position is responsible for leading the initiative to achieve and maintain NCQA Credentials Verification Organization certification for the company.
Matching Summary
The Director provides strategic leadership over provider credentialing, re-credentialing, and payer enrollment functions for a diverse portfolio of healthcare clients.
Skills & Requirements
Must-have
Provider credentialing and re-credentialing management
Payer enrollment and CAQH PECOS systems
NCQA URAC CMS regulatory compliance
Primary source verification protocols
Global team leadership across time zones
Lean Six Sigma process improvement
Nice-to-have
Client relationship building with C-suite
Revenue cycle impact understanding
Delegated credentialing audit experience
Telehealth interstate licensure knowledge
Cross-cultural management practices
Proprietary software platform collaboration
Key Requirements
Bachelor's degree in Healthcare or Business Administration
5-7+ years progressive experience in credentialing and enrollment
Management experience leading teams of 10+ professionals
Deep working knowledge of NCQA and CMS regulations
Experience in vendor or multi-client outsourcing environment