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

Director of Credentialing & Contracting

Plutus Health Inc.guwahati, assam, in
1 day 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 • guwahati, assam, in

    Related jobs
    • Promoted
    • New!
    Practice Director

    Practice Director

    Everest Groupguwahati, assam, in
    Confident decisions driven by deep expertise and tenacious research.Everest Group is a research firm helping business leaders confidently navigate today’s market challenges, driving maximized opera...Show moreLast updated: 13 hours ago
    • Promoted
    • New!
    Contract Performance Manager

    Contract Performance Manager

    Tata Electronicsguwahati, assam, in
    Tata Electronics is a prominent global player in the electronics manufacturing industry, with fast-emerging capabilities in Electronics Manufacturing Services, Semiconductor Assembly and Test, Semi...Show moreLast updated: 13 hours ago
    • Promoted
    Senior Manager / Associate Director - Engineering

    Senior Manager / Associate Director - Engineering

    interface.aiguwahati, assam, in
    Our cutting-edge Generative AI-powered platform serves over 100 banks and credit unions, delivering hyper-personalized customer interactions across voice, chat, and employee-assisting solutions.To ...Show moreLast updated: 15 days ago
    • Promoted
    • New!
    Associate Director

    Associate Director

    Confidentialguwahati, assam, in
    Global Team | Remote / Hybrid Collaboration.Evidence Synthesis | Systematic Reviews | HEOR | RWE | Leadership.A leading global evidence generation consultancy is expanding its Evidence Synthesis (ES)...Show moreLast updated: 13 hours ago
    • Promoted
    • New!
    Cybersecurity Director

    Cybersecurity Director

    Vriba Solutionsguwahati, assam, in
    The Cybersecurity Director is responsible for the strategic vision and scaling of the cybersecurity practice to serve external clients. This leader will ensure robust security governance, risk manag...Show moreLast updated: 13 hours ago
    • Promoted
    Director-FCCS Consolidations(Oracle Financial) Delivery

    Director-FCCS Consolidations(Oracle Financial) Delivery

    Sutherlandguwahati, assam, in
    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: 2 days ago
    • Promoted
    Public Relations Role

    Public Relations Role

    Emeritusguwahati, assam, in
    Emeritus is committed to teaching the skills of the future by making high-quality education accessible and affordable to individuals, companies, and governments around the world.It does this by col...Show moreLast updated: 13 days ago
    • Promoted
    • New!
    Data Privacy Associate Director - Cyber

    Data Privacy Associate Director - Cyber

    Cubical Operations LLPguwahati, assam, in
    Job Description – Data Privacy Lead (Senior Manager / Associate Director) – Noida.Senior Manager / Associate Director.Open to all (Any graduate / post-graduate). We are looking for a Data Privacy Lead...Show moreLast updated: 14 hours ago
    • Promoted
    Management Consultant - 46022

    Management Consultant - 46022

    TuringGuwahati, Republic Of India, IN
    Turing is one of the world’s fastest-growing AI companies, working at the frontier of advanced AI systems.We partner with the world’s leading AI labs to advance model capabilities (reasoning, codin...Show moreLast updated: 30+ days ago
    • Promoted
    Associate Director - Advanced Analytics

    Associate Director - Advanced Analytics

    KMK Consulting Inc.guwahati, assam, 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
    • New!
    TPRM Senior Manager (Qatar)

    TPRM Senior Manager (Qatar)

    Cubical Operations LLPguwahati, India
    Job Description – TPRM Senior Manager (Qatar Travel Requirement).Senior Manager – Third-Party Risk Management (TPRM).Qatar (Frequent travel to / from India). India (Work from India when not travelling...Show moreLast updated: 9 hours ago
    • Promoted
    • New!
    Founder'S Office

    Founder'S Office

    Expression 360 Services India Ltd.Guwahati, Republic Of India, IN
    As part of our continued evolution, we are now looking to onboard a Founder’s Office to work closely with the MD and the broader leadership team. This role is designed for a high-caliber individual ...Show moreLast updated: 7 hours ago
    • Promoted
    • New!
    Founder's Office

    Founder's Office

    Expression 360 Services India Ltd.guwahati, assam, in
    As part of our continued evolution, we are now looking to onboard a Founder’s Office to work closely with the MD and the broader leadership team. This role is designed for a high-caliber individual ...Show moreLast updated: 13 hours ago
    • Promoted
    Director-Fccs Consolidations(Oracle Financial) Delivery

    Director-Fccs Consolidations(Oracle Financial) Delivery

    SutherlandGuwahati, Republic Of India, IN
    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: 2 days ago
    • Promoted
    Director (Management)

    Director (Management)

    Accurate Group of Institutionsguwahati, assam, in
    Accurate Group of Institutions is a renowned educational institution offering a diverse range of courses across various fields of study. Founded in 2006, Accurate has rapidly expanded to become a co...Show moreLast updated: 12 days ago
    • Promoted
    Manager Management Consulting

    Manager Management Consulting

    Mercados Energy Markets IndiaShillong, Meghalaya, India
    We are seeking a skilled and experienced Commercial Support Consultant to provide comprehensive support to Meghalaya Energy Corporation Limited (Holding Company) (MeECL) and Meghalaya Power Distrib...Show moreLast updated: 30+ days ago
    • Promoted
    • New!
    Associate Creative Director

    Associate Creative Director

    Fridoguwahati, assam, in
    Director & Producer (UGC + Product Launch Videos).We are seeking a dynamic and creative.UGC and product launch video productions. The ideal candidate will first shadow our existing production team t...Show moreLast updated: 13 hours ago
    • Promoted
    • New!
    Credentialing Specialist

    Credentialing Specialist

    PangeaEmr LLCguwahati, assam, 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: 13 hours ago