Director, Credentialing and Enrollment @ Foodsmart

About us:

Foodsmart is the leading telenutrition and foodcare solution, backed by a robust network of Registered Dietitians. Our platform is designed to foster healthier food choices, drive lasting behavior change, and deliver long-term health outcomes. Through our highly personalized, digital platform, we guide our 2.2 million members—including those in employer-sponsored health plans, regional and national Medicaid managed care organizations, Medicare Advantage plans, and commercial insurers—on a tailored journey to eating well while saving time and money.

Foodsmart seamlessly integrates dietary assessments and nutrition counseling with online food ordering and cost-effective meal planning for the entire family, optimizing ingredients both at home and on the go. We partner with national and regional retailers across the U.S., many of whom accept SNAP/EBT, making healthier food more accessible. Additionally, we assist members with SNAP enrollment and management, providing tangible access to nutritious food. In 2024, Foodsmart secured a $200 million investment from TPG’s Rise Fund, which supports entrepreneurs dedicated to achieving the United Nations’ Sustainable Development Goals. This investment will help us expand our reach, particularly to low-income workers who are disproportionately affected by diet-related diseases.

At Foodsmart, our mission is to make nutritious food accessible and affordable for everyone, regardless of economic status. We are committed to a set of core values that shape our culture and work environment:

👥 Customer First - You start with the member and work backwards.

🚀 Make It Happen - You act with urgency, use data, and hold high standards.

🤝 One Team - You collaborate with respect and commit as a group.

Whether you're a dietitian, a commercial leader, or a technologist, working at Foodsmart means being part of a team that is passionate, supportive, and driven by a shared purpose. Join us in transforming the way people access and enjoy healthy food.

About the role:

As the Director of Credentialing & Enrollment, you will be the strategic architect and operational leader of our provider network’s eligibility. You are responsible for ensuring that every Registered Dietitian (RD) in our network is licensed, credentialed, and enrolled to provide care across all states that we operate in.

You will lead a high-performing team while partnering with Product, Engineering, and Clinical Ops to automate workflows and shorten the distance between Hired and Billing. You are the ultimate owner of our delegated credentialing agreements and our standing with CMS and private payers.

You will:

Strategic Roadmap:
- Define and execute the long-term vision for credentialing and enrollment, transitioning from manual processes to a tech-enabled, scalable operation.
- Team Leadership:
  - Lead and mentor the Credentialing & Enrollment team.
  - Foster a culture of extreme detail-orientation and accountability.
  - Payer Enrollment & Strategy:
    - Oversee the end-to-end enrollment process for Medicare, Medicaid, and Commercial payers.
    - Be the primary liaison for enterprise contract activations, ensuring our network meets specific payer density and licensing/credentialing requirements.
    - Credentialing
      - Oversee initial credentialing and re-credentialing applications for registered dietitians.
      - Conduct ongoing monitoring of licensure, certifications, and sanctions via state licensing boards and exclusion lists, certification entities, OIG List of Excluded Individuals/Entities (LEIE), National Practitioner Data Bank (NPDB), and System for Award Management (SAM) database.
      - Maintain and update provider licensing, credentials, and insurance records in the credentialing database system
      - Track license and certification expirations for medical staff to ensure timely renewals
      - Delegated Credentialing:
        
        Own and manage delegated credentialing agreements.
        
        Lead all audit activities to ensure 100% compliance with NCQA, URAC, and CMS standards.
        
        Cross-Functional Quarterback:
        
        Act as the operational bridge between Sales (new client launches), Clinical Quality and Operations (provider performance), and RCM (denial management related to enrollment).
        
        Data-Driven Optimization:
        
        Leverage data to identify bottlenecks in the licensing/enrollment funnel.
        
        Use Excel/Sheets to track KPIs such as "Days to Enroll" and "Credentialing Pass Rates."
        
        Leverage AI for process improvement and automation.
        
        Compliance & Committee:
        
        Lead the internal Credentialing Committee, presenting provider files and ensuring all primary source verifications (NPDB, OIG, SAM) are flawless.
        
        Ensure compliance with applicable laws, regulations, procedures, and policies
        
        Maintain knowledge of current credentialing requirements and best practices (e.g., NCQA standards)

You Are:

The Strategic Operator: You can see the big picture of a nationwide telehealth launch but aren't afraid to dive into PECOS or CAQH to troubleshoot a specific provider's enrollment.

The Meticulous Leader: You understand that in credentialing, a 99% accuracy rate is a failure. You have an eye for detail that catches the smallest discrepancies in a provider's work history or licensure.

The Problem Solver: You thrive in ambiguity and can build structure where none exists. If a state board changes its regulations overnight, you are the first to pivot the team's strategy.

The Collaborator: You can explain complex regulatory hurdles to non-clinical stakeholders (Product/Engineering) in a way that inspires technical solutions.

You Have: (Required Qualifications)

Experience: 7+ years in healthcare operations, with at least 3+ years specifically in a leadership role overseeing Credentialing and Payer Enrollment.
Telehealth Expertise: Proven track record of managing multi-state licensure and enrollment for a distributed provider network.
Regulatory Mastery: Deep knowledge of NCQA standards, CMS (Medicare/Medicaid) regulations, and the "alphabet soup" of the industry (CAQH, PECOS, NPPES, NPI).
Technical Proficiency: Intermediate to advanced skills in Excel/Google Sheets and experience with credentialing software (e.g., Medallion).
Education: Bachelor’s degree required; CPCS or CPMSM certification is a significant plus.
Demonstrated ability to manage complex projects and meet deadlines
Excellent organizational and time management skills
Exceptional verbal and written communication skills
Ability to work independently and as part of a team
High level of accuracy and attention to detail

You Have: (Preferred Qualifications)

Certified Provider Credentialing Specialist (CPCS) certification
Familiarity with credentialing processes specific to registered dietitians
Familiarity and comfort with using AI to help automate and streamline processes
Knowledge of nutrition-related certifications and continuing education requirements
Prior experience specifically with Registered Dietitians (RDs) and MNT (Medical Nutrition Therapy billing)
Experience in a high-growth startup environment

About our benefits and perks: Remote-First Company Flexible Unlimited PTO Healthcare Coverage (Medical, Dental, Vision) 401k and FSA Foodsmart is an Equal Opportunity Employer. It is our firm policy to extend equal employment and advancement opportunity to all applicants and employees without regard to race, color, national origin, citizenship status, religious creed, age, sex (including pregnancy, childbirth, breastfeeding, medical conditions related to pregnancy, childbirth and/or breastfeeding), gender, gender identity and expression, sexual orientation, marital status, disability (physical or mental) and/or a medical condition, genetic information, ancestry, veteran status or service in the uniformed services, and any other characteristic protected by applicable federal, state or local law.