Director, Credentialing and Enrollment

At Eleanor Health we are helping people affected by addiction  live amazing lives. We work to fulfill this goal by building and growing the first addiction and mental health services provider designed to deliver a longitudinal, whole-person, value-based model of care for each community member. Our team is ambitious and committed to this unique opportunity, and understands the importance of attracting strong and experienced talent to make our vision for Eleanor Health a reality every day, and for every recovery journey we are entrusted to be a part of.  

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.

• →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
  
  

• 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.