[Hiring] Director of Credentialing @Coyne and Associates

Role Description

We are seeking an experienced and strategic Director of Credentialing & Provider Enrollment to lead all credentialing, enrollment, contracting, compliance, and accreditation activities across our growing multi-state organization. This leadership role is responsible for overseeing provider credentialing operations across four affiliated companies operating in 10 states, ensuring compliance with federal, state, payer, and accreditation requirements. The Director will drive operational excellence through process standardization, policy development, team leadership, and continuous quality improvement while serving as a key partner to clinical, operational, compliance, and executive leadership teams.

Key Responsibilities

• Credentialing & Provider Enrollment Leadership
  • Oversee end-to-end provider credentialing and recredentialing operations across four companies in 10 states.
  • Lead provider enrollment, revalidation, and maintenance activities with Medicaid, Managed Care Organizations (MCOs), Regional Centers, Medicare, and commercial payers.
  • Ensure provider records, licenses, certifications, and credentialing documentation remain current and compliant.
  • Develop and maintain credentialing performance metrics and service-level standards.
• Compliance & Regulatory Oversight
  • Ensure compliance with all applicable federal, state, regional, payer, and accreditation requirements.
  • Conduct internal compliance audits and implement corrective action plans when necessary.
  • Develop, implement, and maintain production and quality standards for the organization's compliance program.
  • Oversee ongoing monitoring of SAM, OIG exclusions, state license sanctions/exclusions, Open Payments, and Medicare/Medicaid Opt-Out status.
  • Serve as the subject matter expert for credentialing, enrollment, and provider compliance regulations.
• Contracting & Payer Relations
  • Lead contracting and enrollment initiatives with Medicaid agencies, Managed Care Organizations, Regional Centers, and commercial payers.
  • Support payer negotiations, contract implementation, and provider network expansion efforts.
  • Build and maintain strong relationships with payers, regulatory agencies, and internal stakeholders.
• Policy, Governance & Accreditation
  • Manage the end-to-end policy lifecycle and governance process.
  • Establish, implement, and maintain organizational SOPs, policies, and procedures.
  • Drive work standardization and process improvement initiatives across credentialing and compliance functions.
  • Lead accreditation activities, including preparation, implementation, and ongoing compliance with Autism Council on Quality (ACQ) standards.
  • Ensure audit readiness and regulatory preparedness across all credentialing and compliance operations.
• Leadership & Team Development
  • Lead, mentor, and develop credentialing, enrollment, and compliance team members.
  • Establish departmental goals, performance expectations, and quality benchmarks.
  • Develop and deliver employee training programs related to credentialing, compliance, enrollment, and policy implementation.
  • Foster a culture of accountability, collaboration, and continuous improvement.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field; Master's degree preferred.
• Experience within ABA, behavioral health, or healthcare services organizations.
• Proficiency with credentialing and provider enrollment platforms, including CAQH, NPPES, CMS I&A, Availity, Salesforce, CentralReach, provider enrollment systems, content management systems (CMS), and Microsoft Office Suite (advanced Excel preferred).
• Minimum of 7 years of experience in provider credentialing, healthcare compliance, provider enrollment, or payer contracting.
• Demonstrated experience with multi-state provider credentialing and payer enrollment operations.
• Strong knowledge of Medicaid, Medicare, commercial payer credentialing, and managed care requirements.

Benefits

• Flexible remote work environment
• Competitive salary and performance-based incentives
• Comprehensive benefits package
• Opportunities for professional development and career growth
• Collaborative and supportive work culture
• Leadership development opportunities

Benefits for Full-Time Employees

• Health, Dental, Chiropractic, and Vision Insurance
• Critical Illness, Voluntary Life, Accident, Hospital Confinement, and Basic Life Insurance
• 401(k)
• Pet Insurance
• Paid Time Off
• 9 Company-Paid Holidays per year, including 6 fixed holidays and 3 floating holidays
• Professional Development Assistance
• Employee Referral Program
• Tuition Reduction Programs through affiliated university partners