Credentialing & Compliance Lead

About Rx Redefined

Healthcare shouldn't be complicated, especially for patients living with chronic conditions. Rx Redefined was founded in 2018 with a mission to positively impact the lives of others by constantly challenging the status quo in healthcare.

Our revolutionary business model enhances healthcare outcomes specifically in the Durable Medical Equipment, Prosthetics, and Orthotics Supplies (DMEPOS) space. Our platform enables physicians to navigate the complexity of compliance and leverage advanced technology to streamline the logistics required to serve their patients effectively, while simultaneously reducing healthcare costs by significantly reducing fraud, waste, and abuse in an industry that desperately needs reform.

We're a fast-growing startup with a simple goal: improve access, outcomes, and patient experience. Our team thrives on solving tough problems, pushing for better solutions, and doing the work that truly makes a difference.

At Rx Redefined we value our people, transparency, dedication, and hard work through a patient-first mentality.

Join us, and help redefine healthcare for the better.

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.

ADA/EEO: The employer will make reasonable accommodations in compliance with the American Disabilities Act of 1990. Rx Redefined provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.

Originally posted on Himalayas