Credentialing Lead

Santa Analead

Operations

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Quick Summary

Overview

Position Summary The Credentialing Lead is a senior healthcare operations leader responsible for provider credentialing, recredentialing, and payer enrollment across a growing medical organization.

Technical Tools

Operations

The Credentialing Lead is a senior healthcare operations leader responsible for provider credentialing, recredentialing, and payer enrollment across a growing medical organization. This role owns the end-to-end credentialing lifecycle for physicians and advanced practice providers (APPs) and ensures compliance with NCQA, CMS, state licensing boards, and payer requirements.
This position focuses on process improvement, compliance, audit readiness, and scalability, ensuring credentialing and enrollment operations support organizational growth without delays or regulatory risk.
This role is eligible for a performance-based bonus incentive.

Responsibilities

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Own the full provider credentialing and recredentialing process for physicians, APPs, and clinical staff
Manage payer enrollment with commercial, Medicare, and Medicaid plans
Serve as the credentialing subject-matter expert for regulatory and accreditation requirements
Maintain credentialing policies, procedures, and documentation standards

Evaluate and improve credentialing workflows, cycle times, and handoffs
Standardize credentialing and enrollment processes to support multi-state growth
Develop SLAs, checklists, escalation paths, and quality controls
Partner with HR, Medical Operations, Revenue Cycle, Compliance, Legal, and Contracting

Ensure compliance with NCQA, CMS, state medical boards, and payer credentialing requirements
Maintain audit-ready credentialing files and lead internal and external audits
Identify credentialing and enrollment risks and implement mitigation plans
Oversee clinician supervisory roster management

Lead, train, and develop credentialing and enrollment staff
Establish performance metrics and accountability
Create documentation and training to reduce operational risk
Scale credentialing team structure and workflows (Director level)

Track and report on credentialing KPIs (time to credential, time to enroll, backlog, expirables)
Provide clear status updates to executive and clinical leadership
Set realistic credentialing and enrollment timelines with stakeholders

Requirements

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5+ years of experience in provider credentialing and payer enrollment
Associate’s degree required; Bachelor’s degree in Healthcare Administration, Business, or related field preferred
Proven experience managing provider credentialing operations in a healthcare or medical group setting
Strong knowledge of NCQA, CMS, payer enrollment, and state licensing requirements
Experience leading credentialing teams and improving operational performance
Strong skills in process design, workflow optimization, and compliance management

Requirements

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CPCS, CPMSM, or equivalent credentialing certification
Experience in healthcare services, medical groups, MSOs, or value-based care organizations
Experience supporting multi-state provider operations
Experience implementing or optimizing credentialing software or enrollment platforms

Pay Range for Posted Region

$105,000—$140,000 USD