Director of Credentialing & Payor Relations

Lone Peak Dental Group; Denver (CO); Hybrid; USD 81,000 - 99,000; Full time

Benefits offered by this job

Hybrid work model

PTO and benefits

Job summary

Lone Peak Dental Group in the Denver area is seeking a Director of Payor Relations & Credentialing to lead credentialing, enrollment, payor relations, and insurance contracting. This leadership role focuses on strategic partnerships with payors, Medicaid participation, and scalable processes to support multiple locations.

You will guide contract negotiations, monitor enrollment timelines, and establish KPIs to improve reimbursement and ensure compliance across states as the practice grows.

Qualifications

• 7 years of experience in dental credentialing with 3–5 years in payor relations.
• Experience in multi-location dental organizations, DSOs, or similar.
• Bachelor's degree required; CPCS CPMSM certification a plus.

Responsibilities

• Lead payor relations, enrollment, credentialing, and contracting functions.
• Negotiate contracts and fee schedules across commercial and Medicaid lines.
• Oversee credentialing for providers across the organization, ensuring timely enrollment.
• Build scalable credentialing processes to support growth and acquisitions.
• Develop metrics and reporting to drive performance and visibility.

Job description

Lone Peak Dental Group Denver CO Hybrid Role Denver Metro Area Starting Salary 90000 plus PTO benefits and more At Lone Peak Dental Group we believe strong relationships thoughtful processes and great people are what keep a growing organization moving forward Our Payor Relations & Credentialing team plays an important role in making sure our providers are credentialed our practices are connected with the right payors and our teams have the support they need to deliver excellent care to children and families We are looking for a Director of Payor Relations & Credentialing who is strategic relationship driven highly organized and confident navigating the complexities of credentialing payor relations contracting and Medicaid This role is a great fit for someone who can see both the big picture and the details build strong external partnerships negotiate effectively and create scalable processes that support a growing multi location dental organization This is a leadership role for someone who enjoys owning their area of expertise solving complex problems and turning opportunities into meaningful results

What Youll Help Lead & Build

The Director of Payor Relations & Credentialing will lead the organizations provider credentialing payor enrollment payor relations and insurance contracting functions This person will serve as a key strategic liaison between Lone Peak and our dental and medical insurance payors while building the processes and relationships needed to support continued growth

Payor Relations & Contracting

Serve as the primary point of contact for dental and medical insurance payors including commercial Medicaid and Medicaid managed care organizations MCOsBuild and maintain strong relationships with payor representatives network managers and state Medicaid contactsLead contract negotiations for new and renewing payor agreements including fee schedule negotiations and network participation termsAnalyze payor contracts and fee schedules to identify opportunities for improved reimbursement across commercial and Medicaid lines of businessServe as a subject matter expert on state Medicaid dental programs including managed care fee for service structures and state specific enrollment and renewal requirementsResolve escalated payor issues including credentialing delays claims disputes related to network status contract interpretation questions and provider enrollment challengesMonitor payor policy changes reimbursement trends and regulatory developments that may impact Lone Peaks practices and providersPartner with Revenue Cycle Compliance and other internal teams to align payor and credentialing strategies with organizational goals

Credentialing & Enrollment

Oversee credentialing and recredentialing for providers across the organization ensuring timely enrollment with contracted payorsBuild and manage scalable credentialing processes that support rapid growth new practice openings acquisitions and expansion into new statesEnsure credentialing activities remain compliant with NCQA CAQH state Medicaid and payor specific requirementsOversee Medicaid provider enrollment revalidation and state specific enrollment requirementsLead mentor and develop a team of credentialing specialists and coordinators including team members supporting Medicaid enrollmentMaintain accurate provider information across credentialing databases payor portals Medicaid systems and internal platformsEstablish and monitor key performance indicators including enrollment turnaround time application accuracy credentialing gaps and enrollment bottlenecksIdentify opportunities to improve efficiency consistency and visibility across the credentialing function

Strategic Leadership

Develop and execute payor strategies that align with Lone Peaks growth plans including network expansion and Medicaid participation by marketPresent credentialing and payor performance metrics to leadership and provide insight into trends challenges and opportunitiesCollaborate with Legal and Compliance on contract review risk mitigation and regulatory requirementsSupport mergers and acquisitions by evaluating payor contracts credentialing status provider enrollment and network participationHelp develop systems processes and reporting that allow the organization to scale while maintaining strong credentialing and payor relationshipsIdentify opportunities to strengthen payor partnerships and improve the overall provider and practice experienceWe are looking for someone who brings 7 years of experience in dental credentialing with at least 35 years in payor relations network management managed care or healthcare contractingHands on experience with Medicaid dental payors and plans including state Medicaid agencies and Medicaid managed care organizationsA proven track record of negotiating payor contracts and fee schedules across commercial and Medicaid lines of businessExperience working within a multi location dental organization DSO or comparable multi site healthcare environmentStrong knowledge of Medicaid provider enrollment systems revalidation cycles and state specific requirements across multiple statesDeep knowledge of dental insurance networks NCQA standards CAQH and state credentialing requirementsExperience managing credentialing and enrollment during periods of rapid growth including de novo openings and acquisitionsStrong analytical skills and the ability to interpret contracts reimbursement data and payor trendsExcellent negotiation communication and relationship management skillsExperience leading mentoring and developing a teamBachelors degree requiredCPCS Certified Provider Credentialing Specialist or CPMSM certification is a plus

What Success Looks Like in Your First Year

Credentialing turnaround times are reduced across the organization including Medicaid enrollment timelinesPayor relationships are strong responsive and productive with clear points of contact and effective escalation pathsNew and renewed payor agreements support the organizations growth and reimbursement goalsCredentialing and enrollment processes are documented scalable and ready to support continued practice growth and acquisitionsLeadership has clear visibility into credentialing performance payor relationships enrollment timelines and key opportunitiesThe Payor Relations & Credentialing team has the structure support and direction needed to operate effectively as Lone Peak continues to grow

Join Us

At Lone Peak Dental Group we are building more than a collection of practices We are building a team that is committed to growing thoughtfully solving problems together and creating better experiences for our providers team members and patients If youre someone who enjoys building relationships navigating complex challenges and creating systems that make a growing organization stronger wed love to hear from you Apply today and help us build the payor and credentialing foundation that will support Lone Peaks next chapter of growth