Full Time Director, Existing Credentialing - Remote (US)

 Director, New 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, New Provider Credentialing will be responsible for overseeing and managing the end-to-end credentialing process for all new healthcare providers joining Theoria Medical. This role will ensure compliance with regulatory standards, payer requirements, and internal timelines while building scalable systems for credentialing in a fast-growth environment. The ideal candidate is a strong leader with deep knowledge of provider credentialing, payer enrollment, and healthcare compliance.

Shift Structure: 

• TBD 

Responsibilities

• Lead the full-cycle credentialing process for all new providers, ensuring timely and accurate completion.
• Manage a credentialing team, including coordinators and specialists, to achieve onboarding goals and maintain high performance.
• Oversee document collection, primary source verifications, background checks, and payer enrollment applications.
• Ensure compliance with federal, state, and payer regulations (e.g., Medicare, Medicaid, NCQA, URAC).
• Collaborate cross-functionally with Talent Acquisition, Legal, HR, and Clinical Leadership to streamline onboarding.
• Develop and maintain credentialing policies, procedures, and SOPs in alignment with industry best practices.
• Track and report key credentialing KPIs, identify bottlenecks, and implement process improvements.
• Stay up to date on industry standards, regulatory changes, and credentialing technology tools.
• Support audits and accreditation processes as needed.
• Partner with the IT and Operations teams to ensure data integrity and system automation where possible.
  
  

Qualifications

• Bachelor’s degree required; advanced degree in healthcare administration, public health, or related field preferred.
• Minimum 5–7 years of progressive experience in healthcare credentialing, including leadership roles.
• Proven success in managing teams, building processes, and working in a high-volume credentialing environment.
• Strong knowledge of state and federal regulations, payer enrollment 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

• 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