Director, Credentialing and Enrollment

About the Role

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.

What You'll Do

• 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
  
  

Who You Are

• 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
  
  Preferred:
  
  
• 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.

Compensation & Benefits

The total target compensation range for this position is $140,000-160,000. The actual compensation offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job.

Eleanor Health offers a generous benefits package to full-time employees, which includes:

• Generous Paid Time Off (prorated for new employees) - unplug, relax, and recharge! 
• • 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 - We are a health first company, and we strive to make our plans affordable and accessible.
• 401(k) plan with 3% match - We are excited to be able to support the long-term financial well-being of our team in a way that reinforces Eleanor’s commitment to equity.
• Short-term disability - We understand that things happen, we want you to feel comfortable to take time to get better.
• Long Term Disability - Picks up where Short Term Disability leaves off (employee paid).
• Life Insurance - Both Eleanor and employee-paid options are available.
• Family Medical Leave - Eleanor Health’s Paid Family & Medical Leave (“PFML”) is designed to provide flexibility and financial peace of mind for approved family and medical reasons such as the birth, adoption, or fostering of a child, and for serious health conditions that you or a family member/significant other might be facing.
• Wellness Perks & Benefits - Mental Health is important to us and we want our employees to have the accessibility you deserve to talk things through, zen with a mindfulness app, or seek assistance from health advocates
• • Mindfulness App Reimbursement
  • EAP with eight face-to-face sessions
  • Virtual health and wellness visits covered by our medical plan.