Talent.com
No longer accepting applications
Director of Credentialing & Contracting

Director of Credentialing & Contracting

Plutus Health Inc.India
2 days ago
Job description

ABOUT PLUTUS HEALTH

Plutus Health is a Dallas-headquartered healthcare revenue cycle management company serving providers across multiple specialties. With 1,600+ employees in the United States, India, and the Philippines, we deliver end-to-end RCM services including medical billing, credentialing, payer enrollment, and contracting.

POSITION OVERVIEW

The Director of Credentialing & Contracting will provide strategic and operational leadership for provider credentialing, re-credentialing, payer enrollment, and payer contract negotiation. This senior role requires deep expertise in healthcare credentialing and payer contracting, strong team leadership skills, and the ability to implement technology and automation to drive efficiency, compliance, and revenue impact across multiple clients and payer relationships.

KEY RESPONSIBILITIES

Strategic Leadership & Operations

  • Develop and execute credentialing and contracting strategies aligned with company growth.
  • Lead and mentor a large, offshore-heavy team of credentialing specialists and contracting analysts.
  • Define and track KPIs, SLAs, and quality metrics; drive continuous improvement.
  • Design scalable processes to support rapid expansion.
  • Partner with RCM operations, sales, finance, legal / compliance, and executive leadership.
  • Provide executive-level reporting on credentialing status, payer performance, and revenue impact.

Credentialing & Provider Enrollment

  • Oversee end-to-end credentialing for 700+ provider applications monthly across specialties.
  • Manage initial credentialing, re-credentialing, and enrollment for Medicare, Medicaid, and commercial payers.
  • Achieve 98%+ SLA compliance and target turnaround times (90–120 days initial; 60–90 days re-credentialing).
  • Ensure accurate primary source verification (licenses, DEA, board certifications, education, work history).
  • Oversee CAQH profile management and hospital privileging across multiple facilities.
  • Maintain strong relationships with payer enrollment teams to expedite approvals.
  • Implement credentialing technology and automation to reduce manual work.

    • Technology, AI & Automation

  • Lead implementation of Agentic AI, RPA, and workflow automation to reduce processing time by 20–30%.
  • Deploy AI tools for application completion, document extraction, and data validation.
  • Implement automated roster management, license monitoring, and re-credentialing alerts.
  • Use contract management platforms for rate tracking, renewal alerts, and fee comparisons.
  • Integrate credentialing systems with billing platforms to ensure clean provider data.
  • Evaluate and implement credentialing and contract management software; build dashboards for real-time metrics.
  • Champion digital transformation initiatives across credentialing and contracting.

    • Payer Contracting & Negotiations

  • Lead payer negotiations for commercial, Medicare Advantage, and Medicaid managed care plans.
  • Analyze reimbursement rates using technology platforms; execute strategies to improve rates by 2–5%.
  • Review and negotiate participation agreements (fee schedules, payment terms, denial / appeal processes, credentialing clauses).
  • Manage contract renewal cycles with proactive planning and automated tracking.
  • Maintain a centralized contract database with rate tracking and expiration alerts.
  • Identify underperforming contracts using analytics and drive renegotiation or termination.
  • Ensure accurate contract loading into billing systems; negotiate carve-outs for high-volume CPT codes.

    • Regulatory Compliance & Quality

  • Ensure compliance with NCQA, URAC, CMS, The Joint Commission, and state-specific standards.
  • Maintain expertise in NPDB, OIG LEIE, SAM.gov, and state sanctions.
  • Oversee credentialing committee processes and documentation.
  • Conduct regular audits of files and contracts; implement corrective actions.
  • Ensure HIPAA compliance and manage delegation oversight activities for IPAs and MSOs.

    • Client & Stakeholder Management

  • Serve as primary escalation point for complex credentialing and contracting issues.
  • Conduct client presentations on status, performance, and strategic recommendations.
  • Support sales during new client implementations and RFPs.
  • Build trusted relationships with provider leadership and practice administrators.
  • Set and manage expectations around timelines and negotiation outcomes.

    • Financial Analysis & Revenue Optimization

  • Analyze payer mix and reimbursement to identify revenue opportunities.
  • Perform fee schedule comparisons and build business cases for renegotiations.
  • Track contract value realization and underpayments using analytics tools.
  • Model financial impact of contract changes and collaborate with finance and RCM teams.

    • REQUIRED QUALIFICATIONS

  • 12–15+ years of progressive experience in US healthcare credentialing and provider enrollment.
  • 5+ years leading teams of 50+ in credentialing and / or contracting.
  • Proven experience managing 500+ credentialing applications monthly at scale.
  • Deep knowledge of Medicare, Medicaid, and commercial payer requirements across multiple states.
  • Demonstrated success negotiating payer contracts with measurable rate improvements.
  • Hands-on experience implementing AI, RPA, or automation in credentialing or contract workflows.
  • Expert knowledge of CAQH, PECOS, NPPES, and major payer portals (UHC, Anthem / BCBS, Cigna, Humana, Aetna).
  • Strong understanding of fee schedules, reimbursement methodologies, and payment terms.
  • Experience with NCQA / URAC / Joint Commission standards.
  • Advanced Excel skills (data analysis, pivot tables, complex formulas); familiarity with BI tools preferred.
  • Excellent client-facing communication and executive presentation skills.
  • Bachelor’s in Healthcare Administration, Business, or related field; Master’s preferred.
  • Ability to work US business hours (evening / night shift from India).

    • PREFERRED QUALIFICATIONS

  • NAMSS certification (CPCS or CPMSM).
  • Track record leading automation projects delivering 20%+ efficiency gains.
  • Background in healthcare RCM or medical billing.
  • Experience managing credentialing for numerous specialties and multi-facility groups.
  • Hands-on experience with credentialing platforms (e.g., Symplr, Cactus, CredentialStream, MD-Staff) and contract management tools.
  • Knowledge of value-based contracts and ACO / CIN credentialing.
  • Experience with delegation oversight for IPAs / MSOs and offshore team management.
  • Familiarity with AI / ML in healthcare operations (document extraction, workflow automation, predictive analytics).

    • TECHNICAL COMPETENCIES

  • Credentialing : CAQH ProView, PECOS, NPPES, state Medicaid systems.
  • Verification : NPDB, OIG LEIE, SAM.gov, SSA Death Master File, Medicare Opt-Out, state licensing boards.
  • Payer Portals : Major commercial payers, Medicare, Medicaid MCOs.
  • Automation & AI : RPA platforms, AI document extraction, workflow automation.
  • Reporting : Advanced Excel; experience with Power BI / Tableau a plus.

    • LEADERSHIP COMPETENCIES

  • Strategic thinking and ability to translate business goals into execution.
  • Strong people leadership : hiring, coaching, and performance management.
  • Proven ability to build and scale high-performing teams.
  • Excellent negotiation and stakeholder management skills.
  • Data-driven decision making and strong financial acumen.
  • Change management and technology adoption experience.
  • Executive presence and strong communication skills.
  • Problem-solving and innovation mindset.

    • KEY SUCCESS METRICS

  • 98%+ SLA achievement and on-time credentialing.
  • Target credentialing turnaround times met or improved.
  • 20–30% reduction in manual effort via automation.
  • 100% CAQH accuracy and clean audits.
  • 2–5% improvement in renegotiated payer rates.
  • Zero critical compliance violations and minimal client escalations.
  • High client satisfaction and strong team engagement.

    • REPORTING STRUCTURE

  • Reports to : VP of Revenue Cycle Management
  • Direct Reports : 3–5 credentialing / contracting managers
  • Team : 50+ credentialing specialists and contracting analysts
  • Partners : RCM operations, finance, sales, client success, legal / compliance, IT / automation

    • COMPENSATION & BENEFITS

  • Competitive salary : ₹35–45 LPA (based on experience).
  • Performance bonus up to 20% of base.
  • Night shift allowance for US hours.
  • Comprehensive health insurance for employee and dependents.
  • NAMSS certification support and continuing education.
  • Hybrid model (3 days office / 2 days remote) in Bangalore (or Coimbatore).
  • Leadership development and exposure to US leadership; potential travel.

    • WORK ENVIRONMENT

  • Location : Bangalore, India (alternate : Coimbatore).
  • Fast-paced, client-focused, deadline-driven environment with high accountability and strong emphasis on innovation.

    • HOW TO APPLY

    Send the following to careers@plutushealthinc.com

    with subject line :

    Director Credentialing & Contracting – [Your Name]

  • Resume detailing credentialing volumes, payer contracts, and automation projects.
  • Cover letter addressing : (a) largest credentialing operation managed, (b) most successful payer negotiation, (c) automation / AI projects led, (d) leadership philosophy.
  • References from prior credentialing or healthcare leadership roles.
    • Create a job alert for this search

    Director Of • India

    Related jobs
    • Promoted
    Client Portfolio Director

    Client Portfolio Director

    Aon Risk Insurance Brokers India Pvt Ltd. (formerly GIB, an Aon company)Republic Of India, IN
    Job Dimensions (Role and Responsibilities) : .Managing the team of Broking Support colleagues who will perform the following functions : . Preparation and analysis of Treaty data & underwriting informat...Show moreLast updated: 16 days ago
    • Promoted
    Contract and Governance Manager

    Contract and Governance Manager

    TELUS DigitalNagpur, IN
    TELUS Digital focuses on the value of human connection to design, build and deliver high-tech, high-touch customer experiences powered by next-gen digital solutions. With over 70,000 team members an...Show moreLast updated: 10 days ago
    • Promoted
    Associate Director - Advanced Analytics

    Associate Director - Advanced Analytics

    KMK Consulting Inc.Nagpur, IN
    KMK is a global data analytics and technology consulting company empowering leaders across the Life Sciences industries to make better data-driven decisions. Our data analytics and software platform...Show moreLast updated: 30+ days ago
    • Promoted
    Client Relationship Director

    Client Relationship Director

    LogFix SCM Solutions Pvt LtdChennai, Republic Of India, IN
    Business Development Manager – Events & Exhibitions / Customer Success Manager.Minimum 10 years (at least 8 years in the Events & Exhibitions industry). English, Hindi, Tamil (Mandatory).Please drop...Show moreLast updated: 6 days ago
    • Promoted
    Client Relationship Director

    Client Relationship Director

    Airtel BusinessPune, Republic Of India, IN
    Job Title : Key Account Manager.Reporting to : Business Manager.Responsible for end-to-end telecom, connectivity, cloud and cybersecurity needs of a set of 30-35 accounts in the Enterprise Segment, p...Show moreLast updated: 16 days ago
    • Promoted
    Contract Lifecycle Manager

    Contract Lifecycle Manager

    ORO LabsNagpur, IN
    ORO Labs is an agentic procurement orchestration company on a mission to humanize the procurement experience.Founded in 2020 by former SAP Ariba product leaders, ORO delivers effortless user experi...Show moreLast updated: 1 day ago
    • Promoted
    • New!
    Director - Financial Planning & Analysis

    Director - Financial Planning & Analysis

    Pocket FMNagpur, IN
    With 100 Billion+ minutes streamed annually, 120 minutes of daily average listening time, and 6 Billion+ total audio plays on our platform,. AI-powered audio streaming platform.What sets us apart? W...Show moreLast updated: 19 hours ago
    • Promoted
    Client Relationship Director

    Client Relationship Director

    CorenzaPune, Republic Of India, IN
    The company operates in the entertainment industry, providing end-to-end creative and technical outsourcing services.We are seeking a seasoned Accounting Manager (Shared Services) to lead and manag...Show moreLast updated: 16 days ago
    • Promoted
    Client Partnership Director

    Client Partnership Director

    TagRepublic Of India, IN
    We are looking for Client Servicing–oriented Account Managers to strengthen our client partnership and delivery interface across regions (AMS, EMEA, and APAC). This role goes beyond project coordina...Show moreLast updated: 10 days ago
    • Promoted
    Client Relationship Director

    Client Relationship Director

    NextynRepublic Of India, IN
    Nextyn is a fast-growing Expert Network and Research firm that connects business leaders, investors, and consultants with subject matter experts worldwide. We help clients make better decisions by p...Show moreLast updated: 16 days ago
    • Promoted
    Client Relationship Director

    Client Relationship Director

    Karamtara EngineeringRepublic Of India, IN
    We are looking for a dynamic and experienced.Tubes, Solar MMS, and Stamping divisions.This role is critical to driving strategic growth and maintaining strong relationships within the domestic mark...Show moreLast updated: 30+ days ago
    • Promoted
    Client Relations Director

    Client Relations Director

    ZARARepublic Of India, IN
    Being a CEM, the roles and responsibilities are : .To understand, anticipate and satisfy the needs of customer, to have an active presence at the point of sale, and to be responsible for the correct ...Show moreLast updated: 3 days ago
    • Promoted
    Contract Manager

    Contract Manager

    Riviera PartnersNagpur, IN
    Riviera is seeking a Contracts Manager to join our dynamic team.In this role, you’ll play a key part in managing the full contract lifecycle across sales, vendor, and partner agreements.We’re looki...Show moreLast updated: 16 days ago
    • Promoted
    Director-FCCS Consolidations(Oracle Financial) Delivery

    Director-FCCS Consolidations(Oracle Financial) Delivery

    SutherlandIndia, India
    For business leaders, these are key factors of success.For us, they’re our core expertise.We work with iconic brands worldwide. We bring them a unique value proposition through market-leading techno...Show moreLast updated: 3 days ago
    • Promoted
    Credentialing Specialist

    Credentialing Specialist

    PangeaEmr LLCNagpur, IN
    PangeaEmr is a USA based comprehensive solution provider for private medical practices, offering a wide range of services through a single dashboard. Our services include credentialing, medical bill...Show moreLast updated: 1 day ago
    • Promoted
    Client Partnership Director

    Client Partnership Director

    Adsto Media HouseRepublic Of India, IN
    We’re Hiring : Account Director.Mumbai | Full-Time | Immediate Joiners Preferred.Adsto is evolving into a full-fledged.We’re growing fast and looking for a dynamic. This isn’t just an account managem...Show moreLast updated: 6 days ago
    • Promoted
    Client Relations Director

    Client Relations Director

    Seventy Event Media GroupRepublic Of India, IN
    Being the face of the company and being responsible for planning, managing, and executing a wide variety of events ranging from media drives, employee meets, dealer conferences, festivals and speci...Show moreLast updated: 30+ days ago
    • Promoted
    Senior Investment Advisor - HNWI & Private Capital Relations

    Senior Investment Advisor - HNWI & Private Capital Relations

    Friendly Franchisees Corporation / Silver Star Real Estate LLCNagpur, IN
    Senior Investment Liaison – HNWI & Private Capital Relations.We are seeking a well-connected and relationship-driven.Senior Investment Liaison – HNWI & Private Capital Relations.We are seeking a we...Show moreLast updated: 30+ days ago