Director, Provider Credentialing & Enrollment

Panoramic Health is on a bold mission to transform value-based kidney care across the nation, and we’re seeking a dynamic Director of Provider Credentialing & Enrollment to help drive that vision forward. Our Director, Provider Credentialing & Enrollment will oversee the credentialing operations by serving as the subject matter expert in the regulatory and operational requirements of credentialing, re-credentialing, delegated credentialing, and expirable data management. This position supervises the first line of contact for internal and external coordination for the department, sets standards for the department and will lead the process to achieve NCQA certification.
Responsibilities include:
• Provides leadership to establish credentialing best practices and oversee the credentialing process to meet targeted go-live dates for new/existing health plan partners
• Develops processes for scaling operations and summarizes the complexity of data and operations into clear explanations
• Supports the manager with the supervision of the credentialling team members including hiring qualified candidates, work allocation, training, performance evaluation and management, staffing ratios, etc.
• Identifies and implements process efficiencies to ensure a streamlined approach to credentialing
• Develops and implements a quality program to ensure accuracy of information and timeliness of submissions
• Provide oversight to the offshore team
• Supports credentialing regulatory activities, including auditing partners and reporting and risks in the network to regulators and leadership
• Provides analytical support and leads the process of collecting, analyzing, and reporting credentialing metrics
• Research government and state requirements for credentialing in new locations and states
• Collaborate with other leaders to identify issues and opportunities that lead to achieving department and company goals
• Builds relationships with insurance plans and confirms that the credentialing process is current based on insurance requirements
• Perform other duties and responsibilities as required, assigned, or requested
Qualifications:
• Bachelor’s degree in business or related field and/or equivalent work experience.
• Minimum of 5 years of credentialing and/or provider enrollment experience in a medical setting at a supervisory level.
• Minimum of 10 years of Medicare, Medicaid, and Commercial Insurance credentialing experience.
• Experience using credentialing software
• Proficiency in Microsoft Office Suite
• Proficiency in CAQH, NPDB, OIG and other regulatory agencies
• Knowledge and experience with health plan transaction sets including benefits.
• Ability to communicate effectively and clearly with all internal and external customers.
• Detail-oriented with excellent follow up
• Solutions-minded, compliance-minded, and results-oriented.
• Knowledge of Medicare Secondary Payor
At Panoramic Health, our values guide everything we do:
• People First – We prioritize the well-being of our patients, providers, and team members.
• Collaboration – We believe in the power of partnership and teamwork to achieve meaningful outcomes.
• Innovation – We embrace change and continuously seek smarter, more effective ways to deliver care.
• Integrity – We hold ourselves to the highest standards of ethics and transparency.
• Accountability – We take ownership of our actions and their impact on those we serve.
If you're a strategic leader with a passion for operational excellence and healthcare innovation, this is your opportunity to make a lasting impact in a fast-growing, purpose-driven organization.


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