Director of Payer Contracting, Network & Provider Credentialing

Aspire Allergy & Sinus; Austin (TX); On-site; USD 150,000 - 190,000; Full time

Benefits offered by this job

Annual incentive

Medical, Dental, Vision Insurance

Life Insurance

Mileage Reimbursement

Paid Time Off

401(k) with Match

Treatment Discounts

Reward Program

Job summary

Aspire Allergy & Sinus seeks a Director of Payer Contracting, Network & Provider Credentialing to drive payer contracting strategy and manage credentialing and enrollment across markets. You will lead contract negotiations, establish governance, and partner with Finance and Operations to improve reimbursement and access.

This role requires building executive payer relationships, directing the Credentialing Manager, and ensuring readiness for new locations and launches.

Qualifications

• Bachelor’s degree or equivalent in a related field.
• 7+ years in provider credentialing, payer enrollment, or healthcare administration.

Responsibilities

• Develop and lead payer contracting, network participation, reimbursement, and credentialing strategy across markets.
• Lead negotiations, renewals, amendments, and escalations with payer partners.
• Establish contract governance with inventories of agreements, products, and rates.
• Partner with Revenue Cycle Management to resolve underpayments and enrollment issues.
• Set policies and performance measures for credentialing and enrollment.

Skills

Payer contracting

Negotiation

Provider credentialing

Financial analysis

Leadership

Communication

Education

Bachelor’s degree in healthcare administration / business / finance

7+ years in credentialing or healthcare administration

Tools

CAQH

PECOS

NPPES

NPDB

Payer portals

Job description

Director of Payer Contracting, Network & Provider Credentialing

Department: Revenue Cycle

Employment Type: Permanent - Full Time

Location: Austin, TX

Description

The Director of Payer Contracting, Network & Provider Credentialing leads Aspire Allergy & Sinus’s payer contracting and network strategy and is accountable for the provider credentialing and enrollment function.

This leader determines which payer products and networks support patient access and financial performance, directs contract negotiations and reimbursement strategy, and establishes the standards and controls that keep providers ready to practice and bill.

The Director builds executive relationships with payers and partners closely with Finance, Revenue Cycle Management, Operations, Clinical Leadership, Legal and Compliance, Human Resources, Talent Acquisition, providers, and the Credentialing Manager.

The Credentialing Manager leads daily credentialing and enrollment operations; the Director sets priorities, monitors performance and risk, and resolves issues requiring strategic or executive decisions.

This position requires full-time onsite work at our headquarters at 5929 Balcones Dr, Austin, TX 78731.

This position requires full-time onsite work at our HQ location at 5929 Balcones Dr, Austin, TX 78731.

Key Responsibilities

Essential Functions

• Develop and lead the enterprise payer contracting, network participation, reimbursement, and provider credentialing strategy across Aspire’s markets.
• Evaluate payer and product participation using patient access, referral opportunities, reimbursement, contract terms, operational requirements, and financial performance.
• Lead negotiations, renewals, amendments, and escalations with commercial and government-related payer partners, in collaboration with Finance, Revenue Cycle Management, and Legal.
• Develop rate and fee schedule strategies; analyze reimbursement trends, proposed terms, and the financial impact of contract changes.
• Maintain executive payer relationships and represent Aspire in discussions involving network participation, contract performance, reimbursement disputes, and strategic growth.
• Establish contract governance, including an accurate inventory of agreements, products, rates, effective dates, notice periods, renewal deadlines, and key obligations.
• Partner with Revenue Cycle Management to identify and address systemic underpayments, denials, network configuration issues, and contract interpretation disputes.
• Set the policies, service standards, controls, staffing priorities, and performance measures for provider credentialing, payer enrollment, and maintenance.
• Lead the credentialing function through the Credentialing Manager, providing direction on resources, priorities, quality, escalations, and team development.
• Ensure credentialing and enrollment plans align with contracted payer products, participation decisions, provider start dates, new locations, and growth initiatives.
• Oversee readiness controls for provider and location launches, including verified payer effective dates, appropriate billing relationships, and documented exceptions.
• Monitor material credentialing risks, including recredentialing, licensure, DEA registration, professional liability coverage, sanctions, audit findings, and enrollment delays; direct escalation and corrective action when needed.
• Establish reporting that connects credentialing performance and payer status to patient access, at-risk revenue, denials, and operational readiness.
• Own payer, network, and credentialing integration strategy for acquisitions, changes of ownership, new markets, new clinics, and legal-entity changes. Direct the Credentialing Manager’s execution of the credentialing workplan.
• Define decision rights and handoffs among Payer Contracting, Credentialing, Revenue Cycle Management, Operations, Finance, and other partners.
• Present executive updates to the CFO and VP of Revenue Cycle Management on negotiations, reimbursement opportunities, network risks, financial exposure, credentialing performance, and growth readiness.
• Perform other duties and lead special projects consistent with the scope and leadership level of the position.

Performance Measures

• Payer renewals, amendments, and notice deadlines are managed within approved timelines.
• Contract recommendations include documented financial, patient-access, and operational analysis.
• Contract terms, rates, products, and effective dates are accurately maintained and communicated to affected teams.
• Material underpayments, network issues, and contract disputes are tracked, escalated, and resolved with measurable outcomes.
• Provider and location launches meet approved payer and credentialing readiness requirements, with risks and exceptions documented before scheduling or billing release.
• Credentialing performance meets established standards for application submission, recredentialing, expirables, file quality, and verified effective dates.
• Payer, network, and credentialing milestones for growth initiatives are completed against approved workplans, with material risks promptly escalated.

Skills, Knowledge & Expertise

Competencies

• Strong understanding of payer contracting, network participation, physician reimbursement, and the financial and operational effects of contract terms.
• Ability to negotiate complex agreements and build productive relationships with payer executives and internal leaders.
• Working knowledge of provider credentialing, payer enrollment, recredentialing, effective dates, and the controls needed to support accurate scheduling and billing.
• Strong financial and analytical skills, including rate modeling, fee schedule analysis, contract performance review, and evaluation of revenue exposure.
• Enterprise leadership that connects payer and credentialing decisions to patient access, provider experience, compliance, and growth.
• Ability to lead through managers, establish accountability, and coordinate work across functions with different priorities.
• Clear written and verbal communication, sound judgment, discretion, and the ability to present recommendations to executive leadership.
• Strong organization and follow-through in a multi-site, multi-state healthcare environment.

Required Education and Experience

• Three to five years of leading people or a major function.
• Bachelor’s degree in healthcare administration, business, finance, management, or a related field; equivalent relevant experience may be considered.
• Seven or more years of progressive experience in provider credentialing, payer enrollment, medical staff services, or healthcare administration.
• Demonstrated experience supporting a multi-site, multi-state physician organization, health system, management services organization, or comparable healthcare enterprise.
• Working knowledge of Medicare, Medicaid and managed Medicaid, commercial payer enrollment, CAQH, PECOS, NPPES, NPDB processes, exclusion screening, revalidation, reassignment, rosters, EFT and ERA, and payer portals.
• Experience establishing service levels, dashboards, quality audits, standard operating procedures, compliance controls, and executive reporting.

Preferred Education and Experience

• Certified Provider Credentialing Specialist, Certified Professional Medical Services Management, or comparable professional credential.
• Experience with allergy, ENT, ambulatory specialty practices, or private-equity-backed healthcare organizations.
• Experience with delegated credentialing, NCQA or URAC-aligned standards, payer audits, or accreditation readiness.
• Experience leading credentialing integration for acquisitions, changes of ownership, new legal entities, or de novo locations.
• Experience with credentialing platforms, EHR or practice management systems, data visualization, workflow automation, and structured process improvement.

Travel

Periodic travel to clinics, payer meetings, acquisitions, audits, and leadership events is required, generally up to 15%.

Job Benefits

• Eligibility for an annual performance-based incentive
• Medical, Dental and Vision Insurance
• Life Insurance
• Mileage Reimbursement
• Generous Paid Time Off and Paid Holidays
• 401(k) + Generous Employer Match
• Treatment Discounts
• Reward Program
• ...AND MORE!