Foodsmart - Director, Credentialing and Enrollment

• 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. • 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) • The Strategic Operator: You can see the big picture of a nationwide telehealth launch but aren't afraid to dive into PECOS or CAQH to troubleshoot a specific provider's enrollment. • The Meticulous Leader: You understand that in credentialing, a 99% accuracy rate is a failure. You have an eye for detail that catches the smallest discrepancies in a provider's work history or licensure. • The Problem Solver: You thrive in ambiguity and can build structure where none exists. If a state board changes its regulations overnight, you are the first to pivot the team's strategy. • The Collaborator: You can explain complex regulatory hurdles to non-clinical stakeholders (Product/Engineering) in a way that inspires technical solutions.