Job description
About Eleanor Health
At Eleanor Health we are helping people affected by addiction live amazing lives. We work to fulfill this goal by building and growing the first addiction and mental health services provider designed to deliver a longitudinal, whole-person, value-based model of care for each community member. Our team is ambitious and committed to this unique opportunity, and understands the importance of attracting strong and experienced talent to make our vision for Eleanor Health a reality every day, and for every recovery journey we are entrusted to be a part of.
About the Role
The Director of Credentialing & Enrollment, plays a critical role at Eleanor Health in ensuring the organization’s credentialing and enrollment activities are accurate and compliant. This role provides strategic leadership over provider credentialing, privileging, and payer enrollment operations. This role ensures clinical staff meet regulatory standards, maintains compliance with bodies like NCQA and The Joint Commission, and optimizes workflows to ensure providers are credentialed and enrolled in a timely manner to support member care and revenue cycle continuity.
What You'll Do
Direct the credentialing and payer enrollment departments, setting strategic goals, policies, and performance standards.
Act as the subject matter expert (SME) 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
Build and maintain strong, positive relationships with Eleanor’s Credentialing and Enrollment vendor through regular communication, meetings, and by serving as a primary point of contact
Be directly responsible for ensuring Eleanor’s Credentialing and Enrollment vendor meets SLAs and identify areas of opportunity to strengthen the partnership with the vendor
Develop dashboards and reports to track key metrics (e.g., turnaround time, expirable tracking, enrollment status) and report out to leadership
Clearly and effectively communicate with providers, Operations Managers and internal stakeholders handling basic questions dealing with the day-to-day operation of credentialing and enrollments
Identify, track, and mitigate compliance risks, escalating issues to senior leadership as needed.
Stay up-to-date with industry regulations and requirements, ensuring compliance at all times
Assist in preparing for and participating in audits and regulatory reviews
Who You Are
7+ years of progressive experience in credentialing and/or payer enrollment, including 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, with comfort operating in a fast-growing, multi-site environment.
Knowledge of relevant federal and state regulations
Knowledge of CAQH, NPPES, PECOS, and payer credentialing portals
Strong knowledge of industry regulations, such as the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC) standards
An analytic mindset - interested in root cause analysis and process improvement with the ability to work with and manipulate large amounts of data
Solid background of developing informative and clear training/documentation materials
Preferred:
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 to identify opportunities and drive effective strategies.
Collaborative and team-oriented mindset to work effectively with cross-functional teams.
Adaptability and ability to thrive in a dynamic environment.
Compensation & Benefits
The total target compensation range for this position is $140,000-160,000. The actual compensation offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job.
Eleanor Health offers a generous benefits package to full-time employees, which includes:
Generous Paid Time Off (prorated for new employees) - unplug, relax, and recharge!
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, with affordable vision coverage -We are a health first company, and we strive to make our plans affordable and accessible.
401(k) plan with 3% match - We are excited to be able to support the long-term financial well-being of our team in a way that reinforces Eleanor’s commitment to equity.
Short-term disability - We understand that things happen, we want you to feel comfortable to take time to get better.
Long Term Disability - Picks up where Short Term Disability leaves off (employee paid).
Life Insurance - Both Eleanor and employee-paid options are available.
Family Medical Leave -Eleanor Health’s Paid Family & Medical Leave (“PFML”) is designed to provide flexibility and financial peace of mind for approved family and medical reasons such as the birth, adoption, or fostering of a child, and for serious health conditions that you or a family member/significant other might be facing.
Wellness Perks & Benefits -Mental Health is important to us and we want our employees to have the accessibility you deserve to talk things through, zen with a mindfulness app, or seek assistance from health advocates
Mindfulness App Reimbursement
EAP with eight face-to-face sessions
Virtual health and wellness visits covered by our medical plan.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.