Director, Credentialing and Enrollment

Foodsmart

3d • $140,000 - $150,000 • Remote

About The Position

As the Director of Credentialing & Enrollment, you will be the strategic architect and operational leader of our provider network’s eligibility. You are responsible for ensuring that every Registered Dietitian (RD) in our network is licensed, credentialed, and enrolled to provide care across all states that we operate in.
You will lead a high-performing team while partnering with Product, Engineering, and Clinical Ops to automate workflows and shorten the distance between Hired and Billing. You are the ultimate owner of our delegated credentialing agreements and our standing with CMS and private payers.

Requirements

• Experience: 7+ years in healthcare operations, with at least 3+ years specifically in a leadership role overseeing Credentialing and Payer Enrollment.
• Telehealth Expertise: Proven track record of managing multi-state licensure and enrollment for a distributed provider network.
• Regulatory Mastery: Deep knowledge of NCQA standards, CMS (Medicare/Medicaid) regulations, and the "alphabet soup" of the industry (CAQH, PECOS, NPPES, NPI).
• Technical Proficiency: Intermediate to advanced skills in Excel/Google Sheets and experience with credentialing software (e.g., Medallion).
• Education: Bachelor’s degree required; CPCS or CPMSM certification is a significant plus.
• Demonstrated ability to manage complex projects and meet deadlines
• Excellent organizational and time management skills
• Exceptional verbal and written communication skills
• Ability to work independently and as part of a team
• High level of accuracy and attention to detail

Nice To Haves

• Certified Provider Credentialing Specialist (CPCS) certification
• Familiarity with credentialing processes specific to registered dietitians
• Familiarity and comfort with using AI to help automate and streamline processes
• Knowledge of nutrition-related certifications and continuing education requirements
• Prior experience specifically with Registered Dietitians (RDs) and MNT (Medical Nutrition Therapy billing)
• Experience in a high-growth startup environment

Responsibilities

• Strategic Roadmap: Define and execute the long-term vision for credentialing and enrollment, transitioning from manual processes to a tech-enabled, scalable operation.
• Team Leadership: Lead and mentor the Credentialing & Enrollment team. Foster a culture of extreme detail-orientation and accountability.
• Payer Enrollment & Strategy: Oversee the end-to-end enrollment process for Medicare, Medicaid, and Commercial payers. Be the primary liaison for enterprise contract activations, ensuring our network meets specific payer density and licensing/credentialing requirements.
• Credentialing: Oversee initial credentialing and re-credentialing applications for registered dietitians.
• Conduct ongoing monitoring of licensure, certifications, and sanctions via state licensing boards and exclusion lists, certification entities, OIG List of Excluded Individuals/Entities (LEIE), National Practitioner Data Bank (NPDB), and System for Award Management (SAM) database.
• Maintain and update provider licensing, credentials, and insurance records in the credentialing database system
• Track license and certification expirations for medical staff to ensure timely renewals
• Delegated Credentialing: Own and manage delegated credentialing agreements. Lead all audit activities to ensure 100% compliance with NCQA, URAC, and CMS standards.
• Cross-Functional Quarterback: Act as the operational bridge between Sales (new client launches), Clinical Quality and Operations (provider performance), and RCM (denial management related to enrollment).
• Data-Driven Optimization: Leverage data to identify bottlenecks in the licensing/enrollment funnel. Use Excel/Sheets to track KPIs such as "Days to Enroll" and "Credentialing Pass Rates." Leverage AI for process improvement and automation.
• Compliance & Committee: Lead the internal Credentialing Committee, presenting provider files and ensuring all primary source verifications (NPDB, OIG, SAM) are flawless. Ensure compliance with applicable laws, regulations, procedures, and policies
• Maintain knowledge of current credentialing requirements and best practices (e.g., NCQA standards)

Benefits

• Remote-First Company
• Flexible Unlimited PTO
• Healthcare Coverage (Medical, Dental, Vision)
• 401k and FSA
• Foodsmart is an Equal Opportunity Employer. It is our firm policy to extend equal employment and advancement opportunity to all applicants and employees without regard to race, color, national origin, citizenship status, religious creed, age, sex (including pregnancy, childbirth, breastfeeding, medical conditions related to pregnancy, childbirth and/or breastfeeding), gender, gender identity and expression, sexual orientation, marital status, disability (physical or mental) and/or a medical condition, genetic information, ancestry, veteran status or service in the uniformed services, and any other characteristic protected by applicable federal, state or local law.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 11-50 employees