Director of Credentialing and Payor Contracting

Behavioral Health Solutions (BHS), a multi-state mental healthcare provider, is seeking a Director of Credentialing and Payor Contracting to oversee and manage the credentialing process for healthcare providers and lead negotiations with insurance payors. This role plays a pivotal part in ensuring the efficient and compliant credentialing of providers while optimizing reimbursement rates and terms through effective payor contract negotiations.

Job Type: Full time (M-F), salaried role, located at our Henderson, NV Headquarters.

Essential Responsibilities:

Credentialing Management

• Oversee and guide the Credentialing team to ensure timely and accurate processing of provider credentialing and re-credentialing applications in compliance with industry regulations and organizational standards.
• Maintain accurate provider data and track MD/DO new licenses and renewals across multiple states.
• Develop, implement, and communicate credentialing policies and procedures to ensure alignment with compliance, regulations, legal requirements, and industry best practices.
• Generate and present reports on operational performance, provider credentialing statuses, and financial impacts to leadership.
• Create and maintain an internal audit process for completeness, accuracy, and compliance with quality standards and pertinent policies.
• Stay updated on changes in regulations and policies that might affect credentialing processes.

Payor Contract Negotiations:

• Lead negotiations of provider contracts with insurance payors to secure favorable rates, terms, and conditions that align with the organization's financial and operational goals.
• Collaborate with Executive and finance teams to ensure contracts comply with all applicable laws, regulations, and industry standards.
• Develop and maintain strong, productive relationships with insurance payor representatives, serving as the primary point of contact for payor inquiries, concerns, and escalations.
• Stay informed about industry trends, reimbursement rates, and changes in healthcare policies to inform contract negotiations and strategy.
• Monitor and assess the performance of payor contracts, ensuring compliance with agreed-upon terms and service levels.
• Proactively manage contract renewals and amendments, identifying opportunities for improvement and optimization.
• Review contract language to ensure compliance with regulations and organizational objectives.
• Analyze contract terms to optimize revenue generation while maintaining cost-effective practices.
• Implement strategies to mitigate contract-related risks and maximize revenue opportunities.
• Ensure timely submission of required documentation and information for contract renewals and updates.
• Perform additional tasks as required to support the organization's credentialing and payor contracting needs.

Requirements

• Bachelor’s degree in Healthcare Management, Business Administration, or a related field (Master’s degree preferred).
• 2-4 years of experience in medical credentialing; or Certified Professional Credentialing Specialist status
• 3-6 years of experience in a Credentialing Manager or similar role.
• Proven ability to lead and motivate a team while managing high-volume of new and existing providers.
• Strong communication skills and the ability to work effectively across departments.
• Experience with multi-state healthcare operations is highly desirable.

Benefits

• W2, Full-time salaried position
• Annual Compensation between $95,000 to $105,000, DOE.
• PTO and Paid Holidays.
• Comprehensive benefits package (Medical, Dental, Vision, Life, and more).
• 401(k) with a company match.