Credentialing Program Lead – Build & Scale (Hybrid/Remote)

CELEBRATION HEALTH & WELLNESS, LLC; Celebration (FL); Hybrid; USD 95,000 - 125,000; Full time

Benefits offered by this job

Medical, dental, vision

401(k) with company match

Paid time off

Hybrid/Remote options

Certification reimbursement

Career growth

Job summary

Medinex Healthcare Solutions in Central Florida near Disney is seeking a Medical Insurance Credentialing Lead to design, launch, and lead a new credentialing and payer enrollment function. Hybrid/Remote options and Central Florida residency are required.

The ideal candidate will build processes, lead a Credentialing Assistant, and oversee compliance with NCQA and payer standards while supporting revenue optimization.

Qualifications

• 4+ years in medical insurance credentialing
• Experience with Medicare, Medicaid, and major commercial payers
• Strong knowledge of CAQH ProView, PECOS, and NPPES
• Experience managing multiple providers
• Excellent organizational skills
• Strong written and verbal communication with payers and providers

Responsibilities

• Design and implement the credentialing program from the ground up
• Develop credentialing workflows, tracking tools, turnaround standards, and SOPs
• Partner with leadership to launch credentialing as a formal service offering
• Establish scalable processes to support future growth and demand
• Manage full lifecycle of provider credentialing and enrollment
• Maintain credentialing files and portal updates; ensure compliance
• Create reporting on turnaround times, payer approvals, and revenue impact

Skills

Leadership

Program design

Documentation

Communication

Provider management

Attention to detail

Education

Bachelor’s degree

Tools

CAQH ProView

PECOS

NPPES

Job description

Medinex Healthcare Solutions in Central Florida near Disney is seeking a Medical Insurance Credentialing Lead to design, launch, and lead a new credentialing and payer enrollment function. Hybrid/Remote options and Central Florida residency are required.

The ideal candidate will build processes, lead a Credentialing Assistant, and oversee compliance with NCQA and payer standards while supporting revenue optimization.