Full Time Director, Existing Credentialing - Remote (US)

 

 Director, Existing Provider Credentialing

Position Type: Full time

Compensation: TBA

Job Location: Remote

Company Overview: 

Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services, including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation. 

As a leading edge, innovative, and quality driven physician group, we continue to expand nationally.  In pursuit of this, we continue to seek talented individuals to join our amazing team and care for our population. We wish to extend a warm welcome to all candidates interested in making a difference in healthcare delivery by joining the Theoria team.

The Director, Existing Provider Credentialing will be responsible for overseeing and managing the maintenance of credentials for all active healthcare providers at Theoria Medical. This critical leadership role ensures that our entire clinical team remains compliant with all regulatory standards and payer requirements through systematic re-credentialing, revalidation, and ongoing monitoring. The ideal candidate is a strong leader with deep expertise in maintaining provider credentials at scale and ensuring uninterrupted compliance in a dynamic healthcare environment.

Shift Structure: 

• TBA

Responsibilities:

• Lead the full-cycle re-credentialing and ongoing monitoring process for all existing providers, ensuring timely and accurate completion of all required activities.
• Manage a credentialing team, including coordinators and specialists, to achieve compliance and re-credentialing goals while maintaining high performance.
• Oversee the management of all expiring documents (licenses, DEA, board certifications), payer re-attestations, and government revalidations.
• Ensure ongoing compliance with federal, state, and payer regulations (e.g., Medicare, Medicaid, NCQA, URAC).
• Collaborate cross-functionally with Clinical Operations, Legal, HR, and Clinical Leadership to ensure seamless compliance and address any credentialing-related issues for active providers.
• Develop and maintain re-credentialing policies, procedures, and SOPs in alignment with industry best practices.
• Track and report key credentialing KPIs (e.g., expirables management, re-credentialing cycle times) to identify risks and implement process improvements.
• Stay up to date on industry standards, regulatory changes, and credentialing technology tools.
• Lead and support audits and accreditation processes as needed.
• Partner with the IT and Operations teams to ensure data integrity and system automation for credential maintenance.

 

Requirements and Qualifications:

• Bachelor's degree is required, though an advanced degree in healthcare administration, public health, or a related field is preferred. An equivalent combination of education and relevant experience will also be considered.
• Minimum 5–7 years of progressive experience in healthcare credentialing, including leadership roles with a focus on re-credentialing and compliance.
• Proven success in managing teams, refining processes, and working in a high-volume credentialing environment.
• Strong knowledge of state and federal regulations, payer re-enrollment/revalidation requirements, and industry accreditation standards.
• Experience with credentialing software platforms (e.g., Modio, CAQH, Verity).
• Excellent communication, project management, and problem-solving skills.
• Ability to work in a fast-paced, remote environment with multiple stakeholders.

Compensation and Benefits:

• Competitive salary and benefits package
• Opportunity to make a significant impact in a growing, mission-driven organization
• Supportive, collaborative, and fast-moving work environment
• Remote work flexibility

Employee must be able to perform the essential functions of this position satisfactorily, with or without a reasonable accommodation.  Employer retains the right to change or assign other duties to this position.