Director of Licensing & Credentialing

U.S. Oral Surgery Management•Irving, TX

1d•$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 with the credentialing vendor to build processes and workflows, define responsibilities across the vendor, practice leaders, and support center, and ensure provider data, licenses, permits, certifications, and privileges remain current, compliant, and audit-ready. The role will build USOSM’s delegated credentialing program, including policies and procedures that meet payer and NCQA requirements, while overseeing traditional credentialing and recredentialing. The Director sets the function’s direction, leads a team of four, manages vendors and tools, uses data and reporting to monitor performance, and communicates with executives, business partners, surgeons, and practice leaders. The position also oversees licensing, payer enrollment, hospital privileges support, vendor performance, service workflows, department staffing and budget, audits, KPIs, and SLAs.

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, a 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.
Proven 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.
Self-starter who works well with limited direction.

Nice To Haves

Dental credentialing experience.
Experience with oral and maxillofacial surgery or specialties that credential 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 and/or credentialing certification such as CPCS or CPMSM.
Experience with Power BI or similar reporting tools.

Responsibilities

Own the relationship with credentialing vendor partners, including quarterly business reviews, contract performance, and escalations to vendor leadership.
Work with vendors to build and refine processes, workflows, and handoffs; establish communication cadence, escalation paths, and performance expectations.
Oversee accuracy and reconciliation of provider data, payer rosters, and application status between USOSM and the vendor.
Establish KPI and SLA reporting to improve credentialing turnaround time and ensure surgeons are ready to treat patients.
Build, lead, and develop a team of four across licensing, credentialing oversight, compliance, and reporting, including hiring, performance management, and succession planning.
Design and document workflows for surgeon onboarding, licensing, hospital privileges, credentialing, recredentialing, and payer enrollment.
Own the department staffing plan and budget, and scale workflows and processes as the organization adds practices, states, and delegated payers.
Develop and deliver education and communication materials for executives, business partners, surgeons, clinical governance board members, and practice leaders.
Oversee oral surgeon licensing, including state dental and medical licenses, board certifications, anesthesia and sedation permits, DEA and state controlled-substance registrations, hospital privileges, and required exams.
Build and maintain a state-by-state reference of licensing, permit, and renewal requirements; partner with compliance and legal experts; track expirations and renewals; maintain audit-ready provider files; and escalate compliance risks.
Partner with practice leaders to ensure new surgeons are licensed and ready to treat, and develop hospital privilege workflows and education materials.
Build and lead the delegated credentialing program, including processes, workflows, policies, procedures, file review standards, and communication with the vendor’s credentialing committee.
Represent USOSM in payer pre-delegation and annual delegation audits, conduct regular internal vendor-file audits, and oversee monthly delegated-payer roster reconciliation and reporting.
Ensure compliance with payer delegation agreements and grow the delegated program with the Director of Payer Strategy where delegation is appropriate.
Oversee traditional credentialing and recredentialing with dental and medical payers not under delegation; monitor applications, follow-up, and effective dates.
Maintain accurate and current 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 for the team to track, prioritize, and resolve credentialing or hospital privileges issues.
Oversee the hospital privileges enrollment model, build workflows and handoffs, support practice leaders, resolve escalated issues, monitor privileges status and reappointment dates, and intervene when lapses are at risk.
Provide training, templates, and guidance to practice leaders on hospital privileges processes.
Manage vendor performance against contractual SLAs and conduct regular performance and business reviews.
Track KPIs including credentialing turnaround time, backlog, effective dates, approval rates, renewal compliance, delegation audit results, roster reconciliation accuracy, hospital privileges 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 and maintain monthly dashboards and status reports for leadership, practices, and the payer strategy team.
Present performance, risks, and recommendations to executive leadership, and lead corrective action with vendors when performance falls short.