Director of Credentialing & Payor Relations

Lone Peak Dental Group•Denver, CO

2d•Hybrid

About The Position

At Lone Peak Dental Group, we believe strong relationships, thoughtful processes, and great people are what keep a growing organization moving forward. Our Payor Relations & Credentialing team plays an important role in making sure our providers are credentialed, our practices are connected with the right payors, and our teams have the support they need to deliver excellent care to children and families. We are looking for a Director of Payor Relations & Credentialing who is strategic, relationship-driven, highly organized, and confident navigating the complexities of credentialing, payor relations, contracting, and Medicaid. This role is a great fit for someone who can see both the big picture and the details, build strong external partnerships, negotiate effectively, and create scalable processes that support a growing multi-location dental organization. This is a leadership role for someone who enjoys owning their area of expertise, solving complex problems, and turning opportunities into meaningful results.

Requirements

7+ years of experience in dental credentialing, with at least 3-5 years in payor relations, network management, managed care, or healthcare contracting.
Hands-on experience with Medicaid dental payors and plans, including state Medicaid agencies and Medicaid managed care organizations.
A proven track record of negotiating payor contracts and fee schedules across commercial and Medicaid lines of business.
Experience working within a multi-location dental organization, DSO, or comparable multi-site healthcare environment.
Strong knowledge of Medicaid provider enrollment systems, revalidation cycles, and state-specific requirements across multiple states.
Deep knowledge of dental insurance networks, NCQA standards, CAQH, and state credentialing requirements.
Experience managing credentialing and enrollment during periods of rapid growth, including de novo openings and acquisitions.
Strong analytical skills and the ability to interpret contracts, reimbursement data, and payor trends.
Excellent negotiation, communication, and relationship-management skills.
Experience leading, mentoring, and developing a team.
Bachelor's degree required.

Nice To Haves

CPCS (Certified Provider Credentialing Specialist) or CPMSM certification is a plus.

Responsibilities

Serve as the primary point of contact for dental and medical insurance payors, including commercial, Medicaid, and Medicaid managed care organizations (MCOs).
Build and maintain strong relationships with payor representatives, network managers, and state Medicaid contacts.
Lead contract negotiations for new and renewing payor agreements, including fee schedule negotiations and network participation terms.
Analyze payor contracts and fee schedules to identify opportunities for improved reimbursement across commercial and Medicaid lines of business.
Serve as a subject matter expert on state Medicaid dental programs, including managed care, fee-for-service structures, and state-specific enrollment and renewal requirements.
Resolve escalated payor issues, including credentialing delays, claims disputes related to network status, contract interpretation questions, and provider enrollment challenges.
Monitor payor policy changes, reimbursement trends, and regulatory developments that may impact Lone Peak's practices and providers.
Partner with Revenue Cycle, Compliance, and other internal teams to align payor and credentialing strategies with organizational goals.
Oversee credentialing and recredentialing for providers across the organization, ensuring timely enrollment with contracted payors.
Build and manage scalable credentialing processes that support rapid growth, new practice openings, acquisitions, and expansion into new states.
Ensure credentialing activities remain compliant with NCQA, CAQH, state, Medicaid, and payor-specific requirements.
Oversee Medicaid provider enrollment, revalidation, and state-specific enrollment requirements.
Lead, mentor, and develop a team of credentialing specialists and coordinators, including team members supporting Medicaid enrollment.
Maintain accurate provider information across credentialing databases, payor portals, Medicaid systems, and internal platforms.
Establish and monitor key performance indicators, including enrollment turnaround time, application accuracy, credentialing gaps, and enrollment bottlenecks.
Identify opportunities to improve efficiency, consistency, and visibility across the credentialing function.
Develop and execute payor strategies that align with Lone Peak's growth plans, including network expansion and Medicaid participation by market.
Present credentialing and payor performance metrics to leadership and provide insight into trends, challenges, and opportunities.
Collaborate with Legal and Compliance on contract review, risk mitigation, and regulatory requirements.
Support mergers and acquisitions by evaluating payor contracts, credentialing status, provider enrollment, and network participation.
Help develop systems, processes, and reporting that allow the organization to scale while maintaining strong credentialing and payor relationships.
Identify opportunities to strengthen payor partnerships and improve the overall provider and practice experience.