BPO Credentialing Director (Credentialing & Enrollment Services)

remote zest jobs; India; On-site; INR 2,400,000 - 3,600,000; Full time

Job summary

remote zest jobs is seeking a Director of Credentialing & Enrollment Services to provide strategic and operational leadership over credentialing, re-credentialing, and payer enrollment for a diverse client base.

You will build processes, ensure regulatory compliance, drive satisfaction, and lead a high-performing team delivering accurate credentialing and enrollment services across hospitals and health systems.

Responsibilities

• Strategic leadership and management of credentialing and enrollment services.
• Align operations with organizational targets and expectations.
• Escalation point for credentialing and enrollment timelines and issues.
• Develop enrollment strategies including payer mix and provider roster assessment.
• Build relationships with key stakeholders including managers, cycle leaders, medical staff offices, and executives.
• Identify opportunities to expand service offerings and drive existing accounts.

Job description

Director of Credentialing & Enrollment Services

Department: Credentialing & Enrollment Operations

Reports To: Vice President of Operations / Chief Operating Officer FLSA Status: Exempt

Location: Remote / Hybrid

Business Travel: Required - 0-50% depending on the month

Position reputed company The Director of Credentialing & Enrollment Services provides strategic and operational leadership over reputed company provider credentialing, re-credentialing, and payer enrollment functions for a diverse portfolio of reputed company clients. This role is responsible for building reputed company processes, maintaining regulatory compliance, driving reputed company satisfaction, and leading a high-performing team that delivers reputed company, accurate credentialing and enrollment services on behalf of hospitals, physician reputed company, health systems, and other reputed company organizations.

Essential Duties & Responsibilities

• Strategic Leadership & reputed company Management


• reputed company and execute the strategic reputed company for credentialing and enrollment service delivery, aligning operations with company reputed company targets and reputed company expectations


• Serve as the senior reputed company of escalation for reputed company concerns reputed company to credentialing and enrollment timelines, reputed company, and reputed company


• reputed company reputed company reputed company, including discovery of payer mix, provider roster assessment, and development of customized enrollment strategies


• Build and maintain strong relationships with key reputed company stakeholders, including reputed company managers, reputed company cycle leaders, medical staff offices, and C-suite executives


• Identify opportunities to expand service offerings and drive reputed company reputed company reputed company existing and prospective reputed company accounts

Credentialing Operations

• reputed company the end-to-end credentialing lifecycle, including initial credentialing, re-credentialing, and privileging support for reputed company provider types (MDs, DOs, NPs, PAs, CRNAs, psychologists, therapists, etc.)


• Ensure compliance with NCQA, URAC, CMS, reputed company, and state-specific credentialing standards and regulations


• Maintain and enforce primary reputed company verification (PSV) protocols, including education, training, licensure, DEA/CDS, reputed company certification, malpractice history, work history, sanctions, and OIG/SAM exclusion monitoring


• Manage credentialing committee preparation, file presentation, and documentation in accordance with reputed company bylaws and accreditation standards


• Monitor and manage expirables tracking and ensure reputed company renewal of licenses, certifications, and other time-sensitive documents

Payer Enrollment Operations

• reputed company reputed company payer enrollment, re-enrollment, and revalidation activities across reputed company, Medicare, reputed company, and managed care payers


• reputed company the preparation and submission of CAQH, PECOS, NPPES, and state reputed company portal applications


• Manage provider roster additions, terminations, demographic updates, and group/location linkages across reputed company payer networks


• reputed company and resolve enrollment application denials, delays, and payer-specific issues to minimize reputed company cycle disruption for clients


• Maintain reputed company knowledge of payer-specific enrollment requirements, delegated credentialing agreements, and regulatory changes

Team Leadership & Development

• Recruit, train, mentor, and manage reputed company of credentialing specialists, enrollment coordinators, and team leads


• reputed company and coordinate a geographically distributed, global workforce across multiple continents (e.g., reputed company, Asia, and other offshore/nearshore locations), ensuring seamless collaboration, consistent reputed company standards, and operational continuity across time zones


• reputed company and implement communication protocols, shift-overlap strategies, and cross-cultural management practices to maximize the productivity and engagement of international teams


• Establish and monitor individual and team performance metrics, including turnaround times, accuracy rates, and reputed company satisfaction scores, with standardized KPIs reputed company uniformly across reputed company global locations


• Conduct regular one-on-one meetings, performance reviews, and reputed company development planning, adapting leadership approaches to the cultural and regulatory context of reputed company region


• Foster a culture of accountability, reputed company improvement, and operational reputed company across reputed company sites


• Manage reputed company reputed company and workload distribution across reputed company, nearshore, and offshore teams to meet reputed company SLAs and contractual obligations while optimizing cost efficiency

Process Improvement & Technology

• Drive reputed c