Director of Licensing & Credentialing

U.S. ORAL SURGERY MANAGEMENT•Irving, TX

8d•$130,000 - $180,000•Onsite

About The Position

The Director, Provider Credentialing & Licensing Operations ensures every USOSM oral surgeon is properly licensed and credentialed with payers, on time and in every state where the organization operates. The director partners closely with credentialing vendors to develop processes and workflows, define responsibilities across vendors, practice leaders, and the support center, and keep licenses, permits, certifications, and privileges current, compliant, and audit-ready. The role will build USOSM’s delegated credentialing program, including policies and procedures that meet payer and regulatory requirements such as NCQA standards, while overseeing traditional credentialing. The director sets the function’s direction, leads a team of four, manages vendors and tools, uses reporting to oversee performance, holds vendors accountable through KPIs and SLAs, and communicates with executives, business partners, surgeons, and practice leaders. Responsibilities also include overseeing licensing and hospital privileges, supporting surgeon onboarding, maintaining accurate provider data and payer rosters, managing credentialing and recredentialing workflows, and developing dashboards and performance reports. The position owns departmental staffing and budget planning and scales the function as USOSM expands its practices, states, and delegated payer relationships.

Requirements

Bachelor’s degree in healthcare administration, business, or a related field.
At least 8 years of experience in provider credentialing, licensing, or payer enrollment in dental, medical, or another healthcare setting.
At least 5 years of people-management experience.
Experience partnering with an outsourced credentialing vendor to build processes and workflows.
Hands-on experience building or running a delegated credentialing program, including policies, credentialing committee, payer delegation audits, and monthly roster reconciliation.
Basic understanding of state licensing, permit, and compliance requirements, with the ability to research requirements state by state.
Experience managing vendors through SLAs, KPIs, and scorecards, and managing a department budget.
Experience designing and documenting workflows, defining team roles, and setting up and managing a ticket-based service process.
Strong reporting experience, including extracting reports and service tickets from credentialing, ticketing, and vendor systems and building KPI dashboards in advanced Excel.
Very strong written and verbal communication skills, including the ability to present to executives.
Ability to work as a self-starter with limited direction.

Nice To Haves

Dental credentialing experience.
Experience with oral and maxillofacial surgery or specialties credentialing with both dental and medical plans.
Experience with credentialing and enrollment software such as CAQH or other tools.
Knowledge of credentialing standards such as NCQA.
Credentialing certification such as CPCS or CPMSM.
Power BI or similar dashboard experience.

Responsibilities

Own relationships with credentialing vendor partners, including quarterly business reviews, contract performance, and escalations.
Develop and refine vendor and in-house workflows, handoffs, communication cadence, escalation paths, and performance expectations.
Oversee the accuracy and reconciliation of provider data, payer rosters, and application status between USOSM and vendors.
Establish KPI and SLA reporting to improve credentialing turnaround time and ensure surgeons are ready to treat patients.
Lead and develop a team of four across licensing, credentialing oversight, compliance, and reporting; manage hiring, performance, and succession planning.
Design and document workflows for surgeon onboarding, licensing, hospital privileges, credentialing, recredentialing, and payer enrollment.
Own department staffing plans and budget, and scale processes as the organization adds practices, states, and delegated payers.
Create and deliver education and communications for executives, business partners, surgeons, clinical governance board members, and practice leaders.
Oversee oral surgeon licensing, including dental and medical licenses, board certifications, anesthesia and sedation permits, DEA and state controlled-substance registrations, hospital privileges, and required exams.
Maintain state-by-state licensing, permit, and renewal references; track expirations and renewals; keep provider files audit-ready; and escalate compliance risks.
Partner with compliance, legal, and practice leaders to meet regulatory requirements and ensure new surgeons are licensed and ready to treat.
Develop hospital privilege workflows and education materials for practice leaders.
Build and lead USOSM’s delegated credentialing program, including payer-specific processes, policies, procedures, file review standards, and credentialing committee communications.
Represent USOSM in payer pre-delegation and annual delegation audits, conduct regular internal vendor-file audits, and oversee monthly roster reconciliation and reporting.
Monitor vendor delegated work for compliance with payer delegation agreements and expand the delegated program with the Director of Payer Strategy where appropriate.
Oversee traditional credentialing and recredentialing with dental and medical payers that are not delegated; monitor applications, follow-up, and effective dates.
Maintain accurate provider data in CAQH, NPPES, and payer rosters, and prioritize payer credentialing based on network decisions from the Director of Payer Strategy.
Establish and manage a ticket-based service process for practice leaders to request help and track, prioritize, and resolve credentialing or hospital privilege issues.
Oversee the hospital privileges enrollment model, supporting practice leaders and resolving escalated issues with hospital medical staff offices.
Monitor privilege status, reappointment dates, and support tickets, intervening when an issue could cause a lapse.
Provide practice leaders with hospital privilege process training, templates, and guidance.
Manage vendors against contractual SLAs and conduct regular performance and business reviews.
Track performance measures including turnaround time, backlog, effective dates, approval rates, renewal compliance, audit results, roster accuracy, ticket volume and resolution time, and time-to-bill for new surgeons.
Extract reports and service tickets from vendor portals, ticketing systems, and credentialing systems; build monthly dashboards and status reports.
Present performance, risks, and recommendations to executive leadership and lead vendor corrective actions when performance falls short.