Dir Credentialing & Payer Enablement

Baylor Genetics; United States; A distancia; USD 180.000 - 240.000; Jornada completa

Descripción de la vacante

Baylor Genetics is seeking a Director of Credentialing & Payer Enablement to lead credentialing, payer enrollment, payer portal management, and payer enablement efforts. You will drive strategy, ensure timely enrollments, and optimize reimbursement across Medicare, Medicaid, Tricare, and commercial payers.

You will partner with Market Access, Revenue Cycle Ops, Billing, Compliance, Finance, Technology, and external partners like Quadax to maintain payer connectivity and readiness for contracting

Formación

• 10+ years of credentialing, provider enrollment, payer operations, or related healthcare functions.
• 5+ years of leadership experience managing teams and performance.
• Extensive Medicare, Medicaid, commercial payer, and Tricare enrollment experience.
• Proven ability to expedite complex enrollments and payer onboarding.
• Experience coordinating with external vendors and payer organizations to resolve issues.
• Healthcare provider or diagnostic laboratory background preferred.

Responsabilidades

• Develop and execute credentialing and payer enablement strategy and goals.
• Lead credentialing, enrollment, and portal administration teams with accountability and quality.
• Partner with Market Access to support payer implementation and contracting readiness.
• Establish KPIs, reporting, and governance for performance.
• Oversee Medicare, Medicaid, Tricare, and commercial payer enrollment activities.
• Ensure timely enrollments, revalidations, and provider record maintenance.
• Drive enrollment turnaround and first-pass approval improvements for reimbursement readiness.
• Lead complex enrollment initiatives for new products, payers, and expansion.
• Oversee payer portal administration, EFT/ERA enrollment, and payer onboarding.
• Collaborate with internal billing teams and external partners to ensure payer readiness.
• Manage vendor performance and ensure payer connectivity across plans.

Conocimientos

Leadership

Strategic thinking

Problem solving

Cross-functional leadership

Educación

Bachelor’s or Associate degree

High School Diploma/GED with 10+ years healthcare ops experience

Descripción del empleo

The Director, Credentialing & Payer Enablement is responsible for the strategic leadership, performance, and continuous improvement of Baylor Genetics’ credentialing, payer enrollment, payer portal management, and payer enablement functions. This role oversees credentialing and recredentialing activities, Medicare, Medicaid, Tricare, and commercial payer enrollments, revalidations, EFT/ERA implementation, payer portal administration, and new payer onboarding readiness. The Director ensures Baylor Genetics maintains the credentials, enrollments, and payer connectivity required to support contracting, billing, and reimbursement operations.

This leader partners closely with Market Access, Revenue Cycle Operations, Billing, Compliance, Finance, Technology, and third-party partners, including Quadax, to ensure timely enrollment completion, payer readiness, and reimbursement optimization. The ideal candidate is highly detail-oriented, self-directed, execution-focused, and experienced navigating complex payer and state enrollment processes while successfully escalating and resolving barriers that impact reimbursement.

KEY RESPONSIBILITIES

Strategic Leadership & Operations

• Develop and execute the credentialing and payer enablement strategy, operating model, and performance goals.
• Lead credentialing, payer enrollment, and portal administration teams while driving accountability, quality, and operational excellence.
• Partner closely with Market Access to support payer implementation and contracting readiness.
• Establish KPIs, reporting, and governance processes to drive performance and accountability.
• Oversee credentialing, recredentialing, Medicare, Medicaid, Tricare, and commercial payer enrollment activities.
• Ensure timely completion of enrollments, revalidations, payer demographic updates, and provider record maintenance.
• Drive improvements in enrollment turnaround times, first-pass approval rates, and reimbursement readiness.
• Lead complex enrollment initiatives supporting new products, payers, and business expansion efforts.
• Oversee payer portal administration, EFT enrollment, ERA enrollment, claims routing readiness, and payer onboarding activities.
• Partner with internal billing teams and third-party partners, including Quadax, to ensure successful payer implementation and reimbursement readiness.
• Manage vendor performance, service expectations, escalations, and operational outcomes.
• Ensure payer connectivity and billing readiness are established and maintained across all contracted health plans.

Escalation, Compliance & Continuous Improvement

• Serve as the executive escalation point with state Medicaid agencies, Medicare contractors, and commercial health plans to resolve enrollment barriers and accelerate approvals.
• Ensure compliance with payer, regulatory, and organizational requirements.
• Lead process improvement initiatives, root-cause analysis, and operational transformation efforts.
• Maintain accurate documentation, policies, procedures, and audit-ready processes.

Leadership & Talent Development

• Develop high-performing teams and foster a culture of accountability, execution, and continuous improvement.
• Establish clear performance expectations and quality standards.
• Hold team members accountable for productivity, accuracy, and service commitments.
• Lead resource planning, employee development, succession planning, and performance management activities.

QUALIFICATIONS

Education

• Bachelor’s or Associate degree preferred; OR
• High School Diploma/GED with 10+ years of progressive healthcare operations experience.

Experience

• 10+ years of experience in credentialing, provider enrollment, payer operations, revenue cycle management, or related healthcare functions.
• 5+ years of leadership experience managing teams and operational performance.
• Extensive experience with Medicare, Medicaid, commercial payer, and Tricare enrollment processes.
• Proven success expediting complex enrollments, revalidations, and payer onboarding activities.
• Experience managing payer portals, EFT/ERA enrollment, and payer enablement functions.
• Demonstrated experience working with external vendors and payer organizations to resolve operational issues and improve outcomes.
• Diagnostic laboratory, molecular diagnostics, or healthcare provider experience preferred.

CORE COMPETENCIES

• Problem Solving & Escalation Management
• Accountability & Execution
• Operational Excellence
• Quality & Compliance
• Cross-Functional Leadership
• Attention to Detail

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• Physical demands for the job (e.g., Must be able to lift 25 lbs, standing for prolonged periods of time, etc.)
• Work environment required for the job duties (e.g., Exposure to laboratory chemicals, etc.)
• Special conditions (e.g. lab/clinical requirements if applicable)

EEO STATEMENT

Baylor Genetics is proud to be an equal opportunity employer committed to fostering an inclusive and diverse workplace. We welcome and encourage applicants from all backgrounds to apply. We do not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, pregnancy, childbirth, or any other status protected by applicable federal, state, or local law. If you need an accommodation during the application process, please contact our Human Resources team.