No longer accepting applications
Director of Credentialing & Contracting
Plutus Health Inc.hyderabad, telangana, in1 day 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 • hyderabad, telangana, in
Related jobs
- Promoted
Director - Clinical Domain
PEOPLE IMPACTHyderabad Description : Job Title : Director - IT Payer (Clinical Domain) Summary : This is a key leadership role...Show moreLast updated: 30+ days ago
- Promoted
Compliance Director
AmgenHyderabad, Republic Of India, IN Azurity Pharmaceuticals is a privately held, specialty pharmaceutical company that focuses on innovative products that meet the needs of underserved patients.
As an industry leader in providing uniq...Show moreLast updated: 29 days ago
- Promoted
Contract Manager
Riviera PartnersHyderabad, 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: 15 days ago
- Promoted
Expert-Contract Management
ConfidentialHyderabad / Secunderabad, Telangana, Chennai, Pune Manage the preparation, evaluation, and finalization of tenders and contracts for infrastructure projects, particularly in railway and highway domains.
Review and interpret contract terms, condition...Show moreLast updated: 19 days ago
- Promoted
US Contract Specialist
ConfidentialHyderabad / Secunderabad, Telangana, India 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 moreLast updated: 1 day ago
- Promoted
Client Relationship Director
Airtel BusinessHyderabad, 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: 15 days ago
- Promoted
Government Proposal and Contracts Director
AugmentareHyderabad, Republic Of India, IN Business Development / Pre-Sales- Augmentare Inc.We are seeking a seasoned Proposal Manager with 8+ years of experience in the IT Services industry.
The ideal candidate will have hands-on expertise ...Show moreLast updated: 30+ days ago
- Promoted
Contracting Associate Manager
ConfidentialHyderabad / Secunderabad, Telangana You will lead or participate in contract management activities, work closely with client engagement teams, and contribute to risk management, portfolio development, and sales support.Additionally, ...Show moreLast updated: 30+ days ago
- Promoted
Director Of Credentialing & Contracting
Plutus Health Inc.Hyderabad, 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 moreLast updated: 1 day ago
- Promoted
Director - Client Partnerships
ConfidentialHyderabad / Secunderabad, Telangana Accordion works at the intersection of sponsors and management teams throughout every stage of the investment lifecycle, providing hands-on, execution-focused support to elevate data and analytics...Show moreLast updated: 7 days ago
- Promoted
Director-Fccs Consolidations(Oracle Financial) Delivery
SutherlandHyderabad, 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: 1 day ago
- Promoted
Director Technology Consulting
ConfidentialHyderabad / Secunderabad, Telangana, India Microsoft Industry Solutions Delivery (ISD) is a global organization hosting over 6,000 strategic sellers, industry and security experts, elite engineers, world-class data scientists and architects...Show moreLast updated: 17 days ago
- Promoted
Director-FCCS Consolidations(Oracle Financial) Delivery
SutherlandHyderabad, 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
US Contracts Lead
CentrapriseHyderabad, Republic Of India, IN We have an excellent job opportunity in our company.Job Title : Us Contracts Manager.Corporate Contracts &ITContracts only).
Lead the negotiation of contracts with clients, vendors, and other extern...Show moreLast updated: 2 days ago
- Promoted
- New!
Practice Director
Everest GroupHyderabad, Telangana, India About Everest Group Confident decisions driven by deep expertise and tenacious research.Everest Group is a research firm helping business leaders confidently navigate today’s market challenges, dr...Show moreLast updated: 4 hours ago
- Promoted
Us Contract Specialist
Tekgence IncSecunderabad, 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 moreLast updated: 1 day ago
- Promoted
Us Contracts Manager.
CentrapriseHyderabad, Telangana, India We have an excellent job opportunity in our company.Job Title : Us Contracts Manager.Corporate Contracts &ITContracts only).
Lead the negotiation of contracts with clients, vendors, and other extern...Show moreLast updated: 2 days ago
- Promoted
- New!
Client Relations Director
DIAGEO IndiaHyderabad, Republic Of India, IN Our Sales team love building relationships, connecting with customers to sell our much-loved brands in new and vibrant markets where they can thrive.
They help sell our iconic brands across 180 coun...Show moreLast updated: 13 hours ago