Director of credentialing
11 hours ago
ABOUT PLUTUS HEALTH Plutus Health is a Dallas-headquartered healthcare revenue cycle management company serving providers across multiple specialties. With 1,600+ employees in the United States, India, and the Philippines, we deliver end-to-end RCM services including medical billing, credentialing, payer enrollment, and contracting. POSITION OVERVIEW The Director of Credentialing & Contracting will provide strategic and operational leadership for provider credentialing, re-credentialing, payer enrollment, and payer contract negotiation. This senior role requires deep expertise in healthcare credentialing and payer contracting, strong team leadership skills, and the ability to implement technology and automation to drive efficiency, compliance, and revenue impact across multiple clients and payer relationships. KEY RESPONSIBILITIES Strategic Leadership & Operations Develop and execute credentialing and contracting strategies aligned with company growth. Lead and mentor a large, offshore-heavy team of credentialing specialists and contracting analysts. Define and track KPIs, SLAs, and quality metrics; drive continuous improvement. Design scalable processes to support rapid expansion. Partner with RCM operations, sales, finance, legal/compliance, and executive leadership. Provide executive-level reporting on credentialing status, payer performance, and revenue impact. Credentialing & Provider Enrollment Oversee end-to-end credentialing for 700+ provider applications monthly across specialties. Manage initial credentialing, re-credentialing, and enrollment for Medicare, Medicaid, and commercial payers. Achieve 98%+ SLA compliance and target turnaround times (90–120 days initial; 60–90 days re-credentialing). Ensure accurate primary source verification (licenses, DEA, board certifications, education, work history). Oversee CAQH profile management and hospital privileging across multiple facilities. Maintain strong relationships with payer enrollment teams to expedite approvals. Implement credentialing technology and automation to reduce manual work. Technology, AI & Automation Lead implementation of Agentic AI, RPA, and workflow automation to reduce processing time by 20–30%. Deploy AI tools for application completion, document extraction, and data validation. Implement automated roster management, license monitoring, and re-credentialing alerts. Use contract management platforms for rate tracking, renewal alerts, and fee comparisons. Integrate credentialing systems with billing platforms to ensure clean provider data. Evaluate and implement credentialing and contract management software; build dashboards for real-time metrics. Champion digital transformation initiatives across credentialing and contracting. Payer Contracting & Negotiations Lead payer negotiations for commercial, Medicare Advantage, and Medicaid managed care plans. Analyze reimbursement rates using technology platforms; execute strategies to improve rates by 2–5%. Review and negotiate participation agreements (fee schedules,
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