Lead Credentialing & Enrollment Operations

Jobtailor; Kentucky; On-site; USD 85,000 - 110,000; Full time

Job summary

Jobtailor is seeking a Senior Provider Credentialing Leader to supervise daily credentialing and payor enrollment operations and to coach and develop Credentialing Specialists onsite. You will oversee initial enrollment, recredentialing, maintenance, and group enrollment while ensuring audit-ready documentation.

The role requires leadership, process optimization, and strong knowledge of CMS/NCQA standards, with collaboration across medical staff, revenue cycle, and payer partners.

Qualifications

• Bachelor's degree in Healthcare Admin, Business Admin, Revenue Cycle Management, or related field.
• Minimum 5 years of provider credentialing, payor enrollment, or closely related healthcare operations experience.
• Minimum 2 years of direct leadership, supervisory, or team lead experience.
• Experience with commercial and governmental payer credentialing or enrollment processes.
• Experience utilizing provider credentialing, enrollment, or provider data management systems.
• Knowledge of healthcare regulatory, accreditation, payer, or delegated credentialing requirements.
• Ability to travel to and work onsite at client, temporary, or corporate office locations as business needs require
• Must reside and be authorized to work within the United States

Responsibilities

• Supervise daily provider credentialing and payor enrollment operations and workflow activities
• Lead and develop Provider Credentialing Specialists through coaching, training, performance management, and workload coordination
• Oversee credentialing, recredentialing, initial enrollment, revalidation, maintenance, termination, group enrollment, facility enrollment, and ownership change activities
• Monitor credentialing and enrollment status, aging reports, work queues, payer follow-up, and application progress
• Investigate and resolve complex credentialing, enrollment, payer, data, documentation, and operational escalations
• Maintain accurate provider credentialing and enrollment information in designated systems and databases
• Coordinate activities with medical staff, revenue cycle, operations, clients, payer representatives, and cross-functional partners
• Ensure compliance with payer requirements, CMS guidelines, NCQA standards, delegated credentialing requirements, regulations, and internal policies
• Maintain complete, accurate, and audit-ready documentation
• Perform quality reviews and routine audits
• Support delegated roster submission, receipt confirmation, payer approval follow-up, and related documentation
• Analyze operational performance metrics and identify process improvement opportunities
• Support standard work procedures, process improvements, quality controls, and best practices
• Monitor regulatory, accreditation, payer, and industry changes
• Prepare reporting and status updates for leadership on performance, progress, risks, and escalations

Education

Bachelor's degree in Healthcare Administration or related field

Tools

Provider Data Management Systems

AI Management Tools

Job description

Jobtailor is seeking a Senior Provider Credentialing Leader to supervise daily credentialing and payor enrollment operations and to coach and develop Credentialing Specialists onsite. You will oversee initial enrollment, recredentialing, maintenance, and group enrollment while ensuring audit-ready documentation.

The role requires leadership, process optimization, and strong knowledge of CMS/NCQA standards, with collaboration across medical staff, revenue cycle, and payer partners.