Director of Payer Contracting, Network & Provider Credentialing

Aspire Allergy & Sinus•Austin, TX

18h•Onsite

About The Position

The Director of Payer Contracting, Network & Provider Credentialing leads Aspire Allergy & Sinus’s payer contracting and network strategy and is accountable for the provider credentialing and enrollment function. This leader determines which payer products and networks support patient access and financial performance, directs contract negotiations and reimbursement strategy, and establishes the standards and controls that keep providers ready to practice and bill. The Director builds executive relationships with payers and partners closely with Finance, Revenue Cycle Management, Operations, Clinical Leadership, Legal and Compliance, Human Resources, Talent Acquisition, providers, and the Credentialing Manager. The Credentialing Manager leads daily credentialing and enrollment operations; the Director sets priorities, monitors performance and risk, and resolves issues requiring strategic or executive decisions.

Requirements

Three to five years of leading people or a major function.
Bachelor’s degree in healthcare administration, business, finance, management, or a related field; equivalent relevant experience may be considered.
Seven or more years of progressive experience in provider credentialing, payer enrollment, medical staff services, or healthcare administration.
Demonstrated experience supporting a multi-site, multi-state physician organization, health system, management services organization, or comparable healthcare enterprise.
Working knowledge of Medicare, Medicaid and managed Medicaid, commercial payer enrollment, CAQH, PECOS, NPPES, NPDB processes, exclusion screening, revalidation, reassignment, rosters, EFT and ERA, and payer portals.
Experience establishing service levels, dashboards, quality audits, standard operating procedures, compliance controls, and executive reporting.

Nice To Haves

Certified Provider Credentialing Specialist, Certified Professional Medical Services Management, or comparable professional credential.
Experience with allergy, ENT, ambulatory specialty practices, or private-equity-backed healthcare organizations.
Experience with delegated credentialing, NCQA or URAC-aligned standards, payer audits, or accreditation readiness.
Experience leading credentialing integration for acquisitions, changes of ownership, new legal entities, or de novo locations.
Experience with credentialing platforms, EHR or practice management systems, data visualization, workflow automation, and structured process improvement.

Responsibilities

Develop and lead the enterprise payer contracting, network participation, reimbursement, and provider credentialing strategy across Aspire’s markets.
Evaluate payer and product participation using patient access, referral opportunities, reimbursement, contract terms, operational requirements, and financial performance.
Lead negotiations, renewals, amendments, and escalations with commercial and government-related payer partners, in collaboration with Finance, Revenue Cycle Management, and Legal.
Develop rate and fee schedule strategies; analyze reimbursement trends, proposed terms, and the financial impact of contract changes.
Maintain executive payer relationships and represent Aspire in discussions involving network participation, contract performance, reimbursement disputes, and strategic growth.
Establish contract governance, including an accurate inventory of agreements, products, rates, effective dates, notice periods, renewal deadlines, and key obligations.
Partner with Revenue Cycle Management to identify and address systemic underpayments, denials, network configuration issues, and contract interpretation disputes.
Set the policies, service standards, controls, staffing priorities, and performance measures for provider credentialing, payer enrollment, and maintenance.
Lead the credentialing function through the Credentialing Manager, providing direction on resources, priorities, quality, escalations, and team development.
Ensure credentialing and enrollment plans align with contracted payer products, participation decisions, provider start dates, new locations, and growth initiatives.
Oversee readiness controls for provider and location launches, including verified payer effective dates, appropriate billing relationships, and documented exceptions.
Monitor material credentialing risks, including recredentialing, licensure, DEA registration, professional liability coverage, sanctions, audit findings, and enrollment delays; direct escalation and corrective action when needed.
Establish reporting that connects credentialing performance and payer status to patient access, at-risk revenue, denials, and operational readiness.
Own payer, network, and credentialing integration strategy for acquisitions, changes of ownership, new markets, new clinics, and legal-entity changes. Direct the Credentialing Manager’s execution of the credentialing workplan.
Define decision rights and handoffs among Payer Contracting, Credentialing, Revenue Cycle Management, Operations, Finance, and other partners.
Present executive updates to the CFO and VP of Revenue Cycle Management on negotiations, reimbursement opportunities, network risks, financial exposure, credentialing performance, and growth readiness.
Perform other duties and lead special projects consistent with the scope and leadership level of the position.