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

Director Of Credentialing & Contracting

Plutus Health Inc.Chicacole, Republic Of India, 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 • Chicacole, Republic Of India, IN

    Related jobs
    • Promoted
    Public Relations Role

    Public Relations Role

    Emeritussrikakulam, andhra pradesh, 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
    Manager - Captive Insurance

    Manager - Captive Insurance

    Selections HR Services Private Limitedsrikakulam, andhra pradesh, in
    Finance & Accounting professional.Lead and manage a large team delivering middle-office services across Accounting, Treasury, Risk & Compliance. Oversee and review management accounts, financial sta...Show moreLast updated: 15 days ago
    • Promoted
    • New!
    Data Privacy Associate Director - Cyber

    Data Privacy Associate Director - Cyber

    Cubical Operations LLPsrikakulam, andhra pradesh, 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: 5 hours ago
    • Promoted
    Senior Director Legal

    Senior Director Legal

    Everisesrikakulam, andhra pradesh, in
    Senior Director – Legal (India).The Senior Director – Legal (India) will serve as the legal and compliance leader for Everise’s India operations, responsible for overseeing all legal, compliance, a...Show moreLast updated: 13 days ago
    • Promoted
    Director-FCCS Consolidations(Oracle Financial) Delivery

    Director-FCCS Consolidations(Oracle Financial) Delivery

    Sutherlandsrikakulam, 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 moreLast updated: 2 days ago
    • Promoted
    Director-Fccs Consolidations(Oracle Financial) Delivery

    Director-Fccs Consolidations(Oracle Financial) Delivery

    SutherlandChicacole, 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
    Oracle Finance Functional Consultant

    Oracle Finance Functional Consultant

    Strattek Consultingsrikakulam, andhra pradesh, in
    Senior Finance Functional Consultant position requires an individual with extensive business knowledge and understanding of Oracle EBS and Fusion Finance Modules along with Projects Finance Modules...Show moreLast updated: 1 day ago
    • Promoted
    • New!
    Associate Director

    Associate Director

    Confidentialsrikakulam, andhra pradesh, 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: 5 hours ago
    • Promoted
    Employee Relations (ER) Shift Lead

    Employee Relations (ER) Shift Lead

    Tata Electronicssrikakulam, andhra pradesh, 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: 14 days ago
    • Promoted
    AML-KYC Lead

    AML-KYC Lead

    Bruc Bondsrikakulam, andhra pradesh, in
    Bruc Bond is a global financial institution operating from Asia-Pacific and Europe.Our mission is to simplify corporate banking. We connect entity clients to a diverse network of partner banks and f...Show moreLast updated: 1 day ago
    • Promoted
    Legal & Compliance Head | Fintech | ARN & RIA

    Legal & Compliance Head | Fintech | ARN & RIA

    Dhan Saarthisrikakulam, andhra pradesh, in
    Hiring a seasoned Legal & Compliance Head with deep knowledge of.Advisory and Distribution businesses.RIA (advisory) & ARN (distribution) businesses. Build clear functional separation : data access, ...Show moreLast updated: 2 days ago
    • Promoted
    Creative Director

    Creative Director

    Radarblocksrikakulam, andhra pradesh, in
    Radarblock is a cutting-edge Web3 marketing and growth agency that helps blockchain and decentralized projects reach their full potential. We specialize in crafting innovative, disruptive, and iconi...Show moreLast updated: 13 days ago
    • Promoted
    Senior Engineer - Digital Assets (Wholesale Banking)

    Senior Engineer - Digital Assets (Wholesale Banking)

    Flyers Softsrikakulam, andhra pradesh, in
    Cloud (AWS / Azure / GCP), Enterprise Architecture (TOGAF), Security (CISSP / CISM), Blockchain / DLT (Hyperledger, Corda, CBP), Agile (PMI‑ACP / Scrum). Deep knowledge of DLT platforms and smart contracts; e...Show moreLast updated: 14 days ago
    • Promoted
    Us Contract Specialist

    Us Contract Specialist

    Tekgence IncChicacole, 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
    • New!
    US Contract Specialist

    US Contract Specialist

    Tekgence Incsrikakulam, 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: 22 hours ago
    • Promoted
    Director (Management)

    Director (Management)

    Accurate Group of Institutionssrikakulam, andhra pradesh, 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: 11 days ago
    • Promoted
    Associate Director / Director - Operations

    Associate Director / Director - Operations

    Nayanta Universitysrikakulam, andhra pradesh, in
    Associate Director / Director - Operations.University Campus, Bavdhan, Pune, Maharashtra 411021.Full-time, On-site (Monday to Friday. flexibility required for events and emergencies).Nayanta Universi...Show moreLast updated: 1 day ago
    • Promoted
    • New!
    Practice Director

    Practice Director

    Everest GroupChicacole, Republic Of India, 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: 4 hours ago