Director of Credentialing and Payer Relationship Management

The Director of Credentialing and Payer Relationship Management is a key leadership role responsible for overseeing and streamlining all aspects of provider credentialing and payer contracting. This role ensures the timely and accurate enrollment and re-credentialing of our clinical providers across all facilities, as well as leading contract negotiations and relationship management with commercial, Medicare Advantage, and Medicaid payers.

The ideal candidate brings a strong background in healthcare credentialing systems, payer contracting, and multi-site operations, and thrives in a fast-paced, growth-oriented environment.

Key Responsibilities:

Credentialing & Enrollment Management

• Oversee the end-to-end provider credentialing and re-credentialing process for 160+ providers across multiple states.
• Manage and optimize use of credentialing software platforms (e.g., Modio, CAQH, PECOS) to ensure compliance, accuracy, and efficiency.
• Ensure compliance with state and federal regulations as well as payer-specific requirements.
• Lead a credentialing team responsible for data integrity, provider file maintenance, and payer enrollment submissions.
• Develop and maintain a comprehensive dashboard to track credentialing timelines and performance KPIs.

Payer Contracting & Relationship Management

• Lead negotiation, renegotiation, and implementation of payer contracts in collaboration with revenue cycle and legal teams.
• Build and maintain strong relationships with commercial and government payer representatives to enhance contract performance and resolve escalations.
• Analyze payer mix, reimbursement trends, and performance metrics to support strategic decisions.
• Serve as a liaison between payers and internal stakeholders including billing, clinical, and operations teams.

Strategic Leadership & Collaboration

• Partner with executive leadership to identify new payer opportunities and support growth into new markets.
• Provide regular reporting on credentialing status and contract performance, including rate improvement opportunities and provider onboarding risks.
• Ensure integration of newly acquired practices into credentialing and payer systems seamlessly.

What We Offer:

• Competitive compensation and performance incentives
• Comprehensive benefits including medical, dental, vision, and 401(k)
• Career growth opportunities within a fast-growing healthcare platform
• A collaborative and mission-driven culture focused on delivering exceptional patient care

• Bachelor’s degree required; Master’s degree in healthcare administration, business, or related field preferred.
• Minimum 7 years of experience in healthcare credentialing and payer contracting, with 3+ years in a leadership role.
• Experience working in a multi-specialty or surgical group practice, ideally within eye care or a similar high-volume specialty.
• Proficient in credentialing software (Modio, OneApp, CAQH) and Medicare/Medicaid portals.
• Demonstrated success in payer contract negotiations and rate analysis.
• Strong organizational, interpersonal, and communication skills.
• Ability to lead and mentor a high-performing credentialing and contracting team.