Director of Credentialing and Payor Contracting

The Director of Payer Credentialing and Contracting leads and manages all aspects of payer enrollment, provider credentialing, and contractual relationships with insurance companies and third-party payers. This role is also responsible for overseeing the onboarding and facility credentialing of all new providers across the organization, ensuring timely participation in payer networks and facility affiliations. The director serves as a strategic liaison between payers, facilities, and internal departments to ensure compliance, maximize reimbursement, and support organizational growth.

• Oversee the onboarding process for new providers, ensuring timely completion of payer and facility credentialing requirements.
• Coordinate with HR, operations, and clinical leadership to align start dates with credentialing timelines.
• Manage and maintain relationships with hospitals, surgery centers, and affiliated medical facilities to secure privileges and facility credentials for providers.
• Ensure providers are appropriately credentialed with all required facilities prior to patient care delivery.
• Create and maintain provider onboarding checklists and credentialing timelines to streamline communication and tracking.
• Lead the end-to-end credentialing, re-credentialing, and payer enrollment process for physicians, mid-level providers, and ancillary staff.
• Ensure compliance with applicable standards, including NCQA, CMS, and state licensing boards.
• Maintain credentialing databases and monitor credentialing status to prevent lapses in participation or privileges.
• Resolve issues with payers and facilities regarding delays, denials, or discrepancies in credentialing and enrollment.
• Lead payer contract negotiations, including terms, reimbursement rates, and performance metrics.
• Conduct detailed contract and rate analyses to evaluate financial impact and identify opportunities for optimization.
• Maintain an organized repository of executed contracts, renewal dates, fee schedules, and credentialing agreements.
• Work with finance and operations teams to model reimbursement scenarios and support strategic decision-making.
• Build and mentor a high-performing team responsible for credentialing, contracting, and onboarding activities.
• Partner with senior leadership to align payer and facility credentialing strategies with the organization’s expansion plans and service line growth.
• Identify and implement improvements in workflow processes, data management, and reporting tools.
• Stay current on payer trends, healthcare compliance changes, and credentialing best practices.

• Actively supports and complies with all components of the compliance program, including, but not limited to, completion of training and reporting of suspected violations of law and Company policy.
• Maintains confidentiality of all information; abides with HIPAA and PHI guidelines at all times.
• Reacts positively to change and performs other duties as assigned.

• Bachelor’s degree in healthcare administration, Business, or a related field required.
• Minimum 7–10 years of experience in payer credentialing, contracting, and provider onboarding.
• Experience managing credentialing with both payers and medical facilities (hospitals, surgery centers, etc.).
• Proven success in managing complex provider onboarding processes in a multi-specialty or multi-location healthcare organization.
• Strong background in payer negotiations and contract performance management.
• In-depth knowledge of credentialing regulations (NCQA, CMS, CAQH, etc.)
• Strong interpersonal, communication, and negotiation skills.
• Proficient in credentialing systems (e.g., VerityStream, Symplr, Modio, IntelliCred) and contract management platforms.
• Excellent project management skills with a focus on process improvement and operational efficiency.
• High attention to detail and ability to manage multiple priorities under tight timelines.
• Ability to work independently and with other team members.
• Excellent interpersonal, oral, and written communication skills.
• Must be detail oriented and self-motivated.
• Excellent customer service skills.
• Anticipate needs in a proactive manner to increase satisfaction.
• The Company reserves the right to modify any bonus/commission structure prospectively at any time for any reason. A bonus/commission is not considered earned until it is paid, and the employee remains with the Company at the time of payment
• Take ownership of job responsibilities by initiating prompt and appropriate follow up and/or action to problems.

We will only employ those who are legally authorized to work in the United States. Any offer of employment is conditional upon the successful completion of a background investigation and drug screen.

We are an equal opportunity employer.