Director of Credentialing & ContractingPlutus Health Inc. • Tirupati, IN
Director of Credentialing & Contracting
Plutus Health Inc. • Tirupati, IN
14 hours ago
Job descriptionOversee 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. 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. 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. 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. 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. 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. 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). 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). 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. 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. 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. 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 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. Location : Bangalore, India (alternate : Coimbatore). Fast-paced, client-focused, deadline-driven environment with high accountability and strong emphasis on innovation. 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.
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
Technology, AI & Automation
Payer Contracting & Negotiations
Regulatory Compliance & Quality
Client & Stakeholder Management
Financial Analysis & Revenue Optimization
REQUIRED QUALIFICATIONS
PREFERRED QUALIFICATIONS
TECHNICAL COMPETENCIES
LEADERSHIP COMPETENCIES
KEY SUCCESS METRICS
REPORTING STRUCTURE
COMPENSATION & BENEFITS
WORK ENVIRONMENT
HOW TO APPLY
Send the following to careers@plutushealthinc.com
with subject line :
Director Credentialing & Contracting – [Your Name]
Create a job alert for this search
Director Of • Tirupati, IN
Related jobs
Contract Manager
Riviera Partners • Tirupati, 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 more
Last updated: 14 days ago • Promoted
Sr. Associate – International Compliance & Entity Management
Transformative Ventures • Tirupati, IN
We are looking for a Senior Associate – Finance to support and manage our international compliance, entity setup, and statutory obligations across multiple geographies.
As we expand globally, this r...Show more
Last updated: 14 hours ago • Promoted • New!
Associate
Synergy Consulting, Inc. • Tirupati, IN
Associate (sub-level, based on interview evaluation).Transaction Delivery and Project Management.Coordinate with the transaction teams to support on-ground development of a project.This would inclu...Show more
Last updated: 14 hours ago • Promoted • New!
Us Contract Specialist
Tekgence Inc • Tirupati, Republic Of India, IN
We are looking for energetic and talented.Candidates should have 1+years of strong experience in.Contracts Specialist responsibilities include : Negotiating contract agreements for products and serv...Show more
Last updated: 6 hours ago • Promoted • New!
Associate Director - Advanced Analytics
KMK Consulting Inc. • Tirupati, 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 more
Last updated: 30+ days ago • Promoted
US Contract Specialist
Tekgence Inc • Tirupati, IN
We are looking for energetic and talented.Candidates should have 1+years of strong experience in.Contracts Specialist responsibilities include : Negotiating contract agreements for products and serv...Show more
Last updated: 14 hours ago • Promoted • New!
Director Of Credentialing & Contracting
Plutus Health Inc. • Tirupati, Republic Of India, IN
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 Philippi...Show more
Last updated: 7 hours ago • Promoted • New!
Director Operations - AI-Powered Global Tech Startup
SkillsCapital • Tirupati, IN
We are a high-growth startup revolutionizing how companies access top-tier tech talent.Our proprietary AI / ML / NLP-powered Talent Cloud and Blockchain-based vetting engine enable global clients to hi...Show more
Last updated: 8 days ago • Promoted
Contract and Governance Manager
TELUS Digital • Tirupati, 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 more
Last updated: 8 days ago • Promoted
Business Development (Web3)
InfraSingularity • Tirupati, IN
InfraSingularity aims to revolutionize the Web3 ecosystem as a pioneering investor and builder.Our long-term vision is to establish ourselves as the first-of-its-kind in this domain, spearheading t...Show more
Last updated: 9 days ago • Promoted
Director-FCCS Consolidations(Oracle Financial) Delivery
Sutherland • tirupati, andhra pradesh, 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 more
Last updated: 1 day ago • Promoted
Director-Fccs Consolidations(Oracle Financial) Delivery
Sutherland • Tirupati, 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 more
Last updated: 1 day ago • Promoted
Public Relations Role
Emeritus • Tirupati, 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 more
Last updated: 13 days ago • Promoted
Director Industry Relations
GITAM Deemed University • Tirupati, Andhra Pradesh, India
Director – Industry Relations, GCGC, GITAM (Deemed to be University), is a key leadership role within the GITAM Career Guidance Centre (GCGC) GCGC (GITAM Career Guidance Center) is a strategic init...Show more
Last updated: 30+ days ago • Promoted
Compliance and Contracts Specialist
Emeritus • Tirupati, IN
The Compliance & Contract Management Services Department is looking for a Compliance and Contracts Associate to assess, analyze, draft, review, negotiate and finalize contracts, compliance, invoice...Show more
Last updated: 14 days ago • Promoted
Technical Director
HEN Technologies • Tirupati, IN
HEN Technologies is a deep-tech company building the world’s first end-to-end intelligent fire suppression ecosystem, powered by AI, IoT, and advanced fluid dynamics.
The company’s mission is to mod...Show more
Last updated: 4 hours ago • Promoted • New!
Associate Director- Statutory Audit- Chennai
MSKA & Associates • Tirupati, IN
Established in 1978, M S K A & Associates is an Indian partnership firm registered with the Institute of Chartered Accountants of India (ICAI) and the PCAOB (US Public Company Accountancy Oversight...Show more
Last updated: 13 hours ago • Promoted • New!
SAP Delivery Director (Solution Head)
Sutherland • Tirupati, IN
SAP solutions delivery— shaping strategy, enabling innovation, and ensuring delivery excellence across one or more transformation programs.
Offshore SAP Delivery Director (Solution Head).Sutherland’...Show more
Last updated: 14 hours ago • Promoted • New!