AVP Provider Enrollment Credentialing
Core
Strategic and operational leadership for provider credentialing, privileging, and payer enrollment to ensure accurate provider enrollment for billing and revenue collection.
Role type
Senior leadership (AVP) in provider credentialing and payer enrollment
Builds
Scalable, compliant infrastructure for provider enrollment and credentialing across a multi-site health system
Domain
Healthcare administration, regulatory compliance, payer relations
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Strategic planning, team leadership (directors/managers), regulatory compliance (NCQA, CMS, Joint Commission), payer enrollment operations, M&A integration, workflow automation, vendor management, financial impact analysis
Preferred skills
Advanced degree in Healthcare/Business Administration, CPCS or CPMSM certification, experience at academic medical centers or large systems ($5B+), PHO governance experience, revenue cycle metrics expertise
Technologies
CAQH, PECOS, NPPES, CredentialStream
Responsibilities
Develop and execute strategy for credentialing and payer enrollment; lead multi-tiered team of directors and managers; drive automation and technology adoption; oversee initial credentialing, reappointment, and privileging processes; ensure compliance with accreditation standards; oversee end-to-end payer enrollment operations; minimize revenue leakage from enrollment delays; advise senior executives on enrollment risk and readiness; partner with Physician Recruitment to streamline onboarding; maintain vendor relations and SLAs.
Seniority
Senior, hands-on IC with significant leadership scope
