Credentialing & Compliance Lead
About the role
The Credentialing & Compliance Lead serves as the end-to-end owner of Medicare DMEPOS credentialing, acting as both a subject matter expert and operational driver.
This role is responsible for navigating complex regulatory requirements, managing high-impact customer interactions, and ensuring all licensing activities are executed with precision, speed, and full compliance.
You will operate cross-functionally, influence process improvements, and play a critical role in enabling our customers to successfully launch and maintain compliant operations.
Duties & Responsibilities
• Own the full DMEPOS credentialing lifecycle, including new enrollments, revalidations, reactivations, updates, and ongoing maintenance
• Track and manage application status to ensure timely and accurate submissions
• Maintain complete and audit-ready documentation aligned with regulatory standards
• Monitor and interpret federal and state regulatory requirements, ensuring continuous compliance
• Proactively implement updates to internal processes, policies, and documentation as requirements evolve
• Act as a safeguard for compliance risk across all credentialing activities
• Serve as the primary liaison with Medicare Administrative Contractors (MACs) and other regulatory bodies
• Partner cross-functionally with internal teams to drive credentialing timelines and remove blockers
• Lead customer-facing interactions to guide providers through licensing requirements and expectations
• Develop, maintain, and continuously improve Credentialing SOPs and documentation standards
• Identify inefficiencies and implement scalable solutions to improve turnaround times and accuracy
• Lead data collection efforts to support reporting, tracking, and performance optimization
• Serve as the internal credentialing expert, advising teams on requirements, risks, and best practices
• Support onboarding and training initiatives related to credentialing processes
• Facilitate onsite customer ID verification processes as needed
• Ability to travel up to 20%, nationwide
Core Qualifications
• Associate's degree required; Bachelor's preferred
• 2+ years in healthcare credentialing, Medicare enrollment, or regulated compliance environments
• Experience working cross-functionally to drive outcomes
How You Operate
• Highly organized with strong attention to detail
• Compliance-driven with sound judgment
• Analytical and solution-oriented
• Clear communicator with a customer-focused approach
• Self-sufficient and accountable; able to work independently
• Experienced in process coordination and documentation
• Maintains strict confidentiality
Preferred
• Experience with MACs (Novitas, Palmetto)
• Familiarity with PECOS, NPPES, and/or EMR systems
• Exposure to DMEPOS credentialing requirements
Benefits & Perks
• Medical, dental, and vision coverage - 100% of the employee premium is covered by Rx Redefined.
• Professional growth - be part of a high-growth team where you'll learn quickly and see the impact of your work.
• Bonus program eligible.
The Credentialing & Compliance Lead serves as the end-to-end owner of Medicare DMEPOS credentialing, acting as both a subject matter expert and operational driver.
This role is responsible for navigating complex regulatory requirements, managing high-impact customer interactions, and ensuring all licensing activities are executed with precision, speed, and full compliance.
You will operate cross-functionally, influence process improvements, and play a critical role in enabling our customers to successfully launch and maintain compliant operations.
Duties & Responsibilities
• Own the full DMEPOS credentialing lifecycle, including new enrollments, revalidations, reactivations, updates, and ongoing maintenance
• Track and manage application status to ensure timely and accurate submissions
• Maintain complete and audit-ready documentation aligned with regulatory standards
• Monitor and interpret federal and state regulatory requirements, ensuring continuous compliance
• Proactively implement updates to internal processes, policies, and documentation as requirements evolve
• Act as a safeguard for compliance risk across all credentialing activities
• Serve as the primary liaison with Medicare Administrative Contractors (MACs) and other regulatory bodies
• Partner cross-functionally with internal teams to drive credentialing timelines and remove blockers
• Lead customer-facing interactions to guide providers through licensing requirements and expectations
• Develop, maintain, and continuously improve Credentialing SOPs and documentation standards
• Identify inefficiencies and implement scalable solutions to improve turnaround times and accuracy
• Lead data collection efforts to support reporting, tracking, and performance optimization
• Serve as the internal credentialing expert, advising teams on requirements, risks, and best practices
• Support onboarding and training initiatives related to credentialing processes
• Facilitate onsite customer ID verification processes as needed
• Ability to travel up to 20%, nationwide
Core Qualifications
• Associate's degree required; Bachelor's preferred
• 2+ years in healthcare credentialing, Medicare enrollment, or regulated compliance environments
• Experience working cross-functionally to drive outcomes
How You Operate
• Highly organized with strong attention to detail
• Compliance-driven with sound judgment
• Analytical and solution-oriented
• Clear communicator with a customer-focused approach
• Self-sufficient and accountable; able to work independently
• Experienced in process coordination and documentation
• Maintains strict confidentiality
Preferred
• Experience with MACs (Novitas, Palmetto)
• Familiarity with PECOS, NPPES, and/or EMR systems
• Exposure to DMEPOS credentialing requirements
Benefits & Perks
• Medical, dental, and vision coverage - 100% of the employee premium is covered by Rx Redefined.
• Professional growth - be part of a high-growth team where you'll learn quickly and see the impact of your work.
• Bonus program eligible.