Dir Credentialing & Payer Enablement

Baylor Genetics•,

6d•Remote

About The Position

The Director, Credentialing & Payer Enablement is responsible for the strategic leadership, performance, and continuous improvement of Baylor Genetics' credentialing, payer enrollment, payer portal management, and payer enablement functions. The role oversees credentialing and recredentialing; Medicare, Medicaid, Tricare, and commercial payer enrollments; revalidations; EFT/ERA implementation; payer portal administration; and new payer onboarding readiness. The Director ensures Baylor Genetics maintains the credentials, enrollments, and payer connectivity required to support contracting, billing, and reimbursement operations. This leader partners with Market Access, Revenue Cycle Operations, Billing, Compliance, Finance, Technology, and third-party partners, including Quadax, to ensure timely enrollment completion, payer readiness, and reimbursement optimization. The position requires a detail-oriented, self-directed, execution-focused leader experienced in complex payer and state enrollment processes and in escalating and resolving barriers that affect reimbursement. The Director leads credentialing, payer enrollment, and portal administration teams; establishes performance goals, KPIs, reporting, and governance; and drives accountability, quality, and operational excellence. The role manages vendor performance and payer connectivity, serves as an executive escalation point with government agencies and commercial health plans, and leads process improvement, compliance, documentation, resource planning, and talent development.

Requirements

At least 10 years of experience in credentialing, provider enrollment, payer operations, revenue cycle management, or related healthcare functions.
At least 5 years of leadership experience managing teams and operational performance.
Extensive experience with Medicare, Medicaid, commercial payer, and Tricare enrollment processes.
Proven success expediting complex enrollments, revalidations, and payer onboarding activities.
Experience managing payer portals, EFT/ERA enrollment, and payer enablement functions.
Demonstrated experience working with external vendors and payer organizations to resolve operational issues and improve outcomes.
Bachelor's or Associate degree preferred; alternatively, a High School Diploma/GED with 10 or more years of progressive healthcare operations experience.

Nice To Haves

Diagnostic laboratory, molecular diagnostics, or healthcare provider experience.

Responsibilities

Develop and execute the credentialing and payer enablement strategy, operating model, and performance goals.
Lead credentialing, payer enrollment, and portal administration teams while driving accountability, quality, and operational excellence.
Partner with Market Access to support payer implementation and contracting readiness.
Establish KPIs, reporting, and governance processes to drive performance and accountability.
Oversee credentialing, recredentialing, Medicare, Medicaid, Tricare, and commercial payer enrollment activities.
Ensure timely completion of enrollments, revalidations, payer demographic updates, and provider record maintenance.
Improve enrollment turnaround times, first-pass approval rates, and reimbursement readiness.
Lead complex enrollment initiatives supporting new products, payers, and business expansion efforts.
Oversee payer portal administration, EFT enrollment, ERA enrollment, claims routing readiness, and payer onboarding.
Partner with internal billing teams and third-party partners, including Quadax, to ensure successful payer implementation and reimbursement readiness.
Manage vendor performance, service expectations, escalations, and operational outcomes.
Ensure payer connectivity and billing readiness are established and maintained across contracted health plans.
Serve as the executive escalation point with state Medicaid agencies, Medicare contractors, and commercial health plans to resolve enrollment barriers and accelerate approvals.
Ensure compliance with payer, regulatory, and organizational requirements.
Lead process improvement initiatives, root-cause analysis, and operational transformation efforts.
Maintain accurate documentation, policies, procedures, and audit-ready processes.
Develop high-performing teams and foster a culture of accountability, execution, and continuous improvement.
Establish clear performance expectations and quality standards, and hold team members accountable for productivity, accuracy, and service commitments.
Lead resource planning, employee development, succession planning, and performance management activities.