Director, Credentialing and Enrollment

Eleanor Health

7h•$140,000 - $160,000

About The Position

The Director of Credentialing & Enrollment plays a critical role at Eleanor Health in ensuring the organization’s credentialing and enrollment activities are accurate and compliant. This role provides strategic leadership over provider credentialing, privileging, and payer enrollment operations. This role ensures clinical staff meet regulatory standards, maintains compliance with bodies like NCQA and The Joint Commission, and optimizes workflows to ensure providers are credentialed and enrolled in a timely manner to support member care and revenue cycle continuity.

Requirements

7+ years of progressive experience in credentialing and/or payer enrollment, including at least 3 years in a leadership role.
Proven ability to manage teams, build scalable processes, and drive operational efficiency on a national scale.
Strong analytical, organizational, and communication skills, with comfort operating in a fast-growing, multi-site environment.
Knowledge of relevant federal and state regulations.
Knowledge of CAQH, NPPES, PECOS, and payer credentialing portals.
Strong knowledge of industry regulations, such as the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC) standards.
An analytic mindset - interested in root cause analysis and process improvement with the ability to work with and manipulate large amounts of data.
Solid background of developing informative and clear training/documentation materials.

Nice To Haves

Startup experience preferred.
Athena experience preferred.
Experience with delegated credentialing arrangements and health plan audits.
Demonstrated ability to successfully lead process improvement projects.
Excellent analytical and problem-solving skills to identify opportunities and drive effective strategies.
Collaborative and team-oriented mindset to work effectively with cross-functional teams.
Adaptability and ability to thrive in a dynamic environment.

Responsibilities

Direct the credentialing and payer enrollment departments, setting strategic goals, policies, and performance standards.
Act as the subject matter expert (SME) for provider credentialing/accreditation/insurance regulations, policies, guidelines, and standards.
Build and manage a high-performing team, including hiring, training, coaching, and performance management.
Develop and implement process improvements to reduce enrollment turnaround time and credentialing backlogs.
Collaborate with Revenue Operations to resolve enrollment-related claim denials or delays.
Build and maintain strong, positive relationships with Eleanor’s Credentialing and Enrollment vendor through regular communication, meetings, and by serving as a primary point of contact.
Be directly responsible for ensuring Eleanor’s Credentialing and Enrollment vendor meets SLAs and identify areas of opportunity to strengthen the partnership with the vendor.
Develop dashboards and reports to track key metrics (e.g., turnaround time, expirable tracking, enrollment status) and report out to leadership.
Clearly and effectively communicate with providers, Operations Managers and internal stakeholders handling basic questions dealing with the day-to-day operation of credentialing and enrollments.
Identify, track, and mitigate compliance risks, escalating issues to senior leadership as needed.
Stay up-to-date with industry regulations and requirements, ensuring compliance at all times.
Assist in preparing for and participating in audits and regulatory reviews.

Benefits

Generous Paid Time Off (prorated for new employees)
12 Vacation days
12 Wellness (Sick) days
3 Floating holidays
9 Company-observed holidays
Jury Duty, Voting Leave, and other forms of paid time off may be available
Eleanor-paid medical and dental insurance plans, with affordable vision coverage
401(k) plan with 3% match
Short-term disability
Long Term Disability
Life Insurance - Both Eleanor and employee-paid options are available.
Family Medical Leave
Wellness Perks & Benefits
Mindfulness App Reimbursement
EAP with eight face-to-face sessions
Virtual health and wellness visits covered by our medical plan.