Director, Credentialing and Enrollment

Job not on LinkedIn

🔥 6 minutes ago

🇺🇸 United States – Remote

💵 $140k - $160k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 0%

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Eleanor Health

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Eleanor Health is an outpatient addiction treatment program that provides online services for people in recovery from substance use disorder. They offer judgment-free support, affordable treatment plans, and personalized care. Eleanor Health focuses on a whole-person approach to recovery, addressing both the medical condition and underlying causes of addiction. Services include virtual drug and alcohol rehab, individual appointments with licensed clinicians, safe medical detox, medication-assisted treatment, therapy, and peer support. The company operates in multiple states and provides state-wide online appointments with select in-person services.

📋 Description

• Direct the credentialing and payer enrollment departments • Set strategic goals, policies, and performance standards • Serve as subject matter expert 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 • Manage the relationship with Eleanor’s Credentialing and Enrollment vendor • Serve as primary point of contact for the vendor • Ensure the vendor meets SLAs and identify opportunities to strengthen the partnership • Develop dashboards and reports tracking turnaround time, expirable tracking, and enrollment status • Report key metrics to leadership • Communicate with providers, Operations Managers, and internal stakeholders regarding day-to-day credentialing and enrollment operations • Identify, track, and mitigate compliance risks, escalating issues to senior leadership as needed • Stay current with industry regulations and requirements • Assist with audits and regulatory reviews

🎯 Requirements

• 7+ years of progressive experience in credentialing and/or payer enrollment • 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 • Knowledge of relevant federal and state regulations • Knowledge of CAQH, NPPES, PECOS, and payer credentialing portals • Strong knowledge of NCQA and The Joint Commission (TJC) standards • Analytic mindset with root cause analysis and process improvement capabilities • Ability to work with and manipulate large amounts of data • Background developing informative and clear training/documentation materials • 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 • Collaborative and team-oriented mindset • Adaptability and ability to thrive in a dynamic environment

🏖️ Benefits

• Generous Paid Time Off (prorated for new employees) • 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 • Affordable vision coverage • 401(k) plan with 3% match • Short-term disability • Long Term Disability (employee paid) • Life Insurance, including Eleanor- and employee-paid options • Paid Family & Medical Leave (PFML) • Mindfulness App Reimbursement • EAP with eight face-to-face sessions • Virtual health and wellness visits covered by the medical plan • Remote work arrangement