Director of Payer Credentialing & Provider Enrollment

PsychPlus; Houston (TX); On-site; USD 80,000 - 100,000; Full time

Job summary

PsychPlus in Houston, TX seeks an experienced Director of Payer Credentialing & Provider Enrollment to lead credentialing and enrollment operations across the organization, ensuring providers are properly credentialed, enrolled, and maintained with payers.

You will oversee initial credentialing, recredentialing, and maintenance, ensure timely submissions to commercial and government payers (Medicare/Medicaid), and maintain records in payer portals and internal systems.

Qualifications

• Previous healthcare credentialing and provider enrollment experience is required.
• Experience with commercial and government payers including Medicare/Medicaid.
• Strong understanding of credentialing, re-credentialing, and payer enrollment processes.
• Experience managing credentialing documentation, applications, expirables, and provider records.
• Strong attention to detail and organizational skills.
• Excellent communication and problem-solving abilities.
• Ability to manage multiple priorities and meet deadlines.
• Leadership or management experience preferred.
• Willingness to work onsite in Houston, TX.

Responsibilities

• Lead and oversee all provider credentialing and payer enrollment activities.
• Manage initial credentialing, re-credentialing, and maintenance processes.
• Ensure accurate and timely submission of provider applications to payers.
• Maintain provider information and enrollment records across portals and systems.
• Monitor timelines and resolve delays, discrepancies, and issues.
• Develop and maintain standardized credentialing workflows.
• Ensure compliance with payer requirements and regulations.
• Collaborate with providers, leadership, billing, and revenue cycle teams.
• Track and report metrics related to credentialing, enrollment, expirations, and payer participation.
• Identify opportunities to improve processes and reduce enrollment delays.
• Ensure providers remain active and properly enrolled with participating payers.
• Maintain up-to-date knowledge of payer policies and regulatory requirements.
• Provide leadership, training, and guidance to credentialing staff.

Skills

Leadership

Communication

Problem solving

Attention to detail

Multitasking

Team management

Education

Bachelor's degree in Healthcare Administration

Tools

CAQH

Payer portals

Credentialing software

Job description

PsychPlus is seeking an experienced Director of Payer Credentialing & Provider Enrollment to lead and oversee credentialing and payer enrollment operations across the organization. This role will be responsible for ensuring providers are properly credentialed, enrolled, and maintained with commercial and government payers while supporting compliance, operational efficiency, and timely reimbursement.

The ideal candidate has previous healthcare credentialing and provider enrollment experience, strong knowledge of payer requirements, and the leadership skills needed to manage processes, teams, and cross-functional relationships.

Key Responsibilities

• Lead and oversee all provider credentialing and payer enrollment activities.
• Manage initial credentialing, re-credentialing, provider enrollment, and maintenance processes.
• Ensure accurate and timely submission of provider applications to commercial and government payers.
• Maintain provider information and enrollment records across payer portals and internal systems.
• Monitor credentialing and enrollment timelines and resolve delays, discrepancies, and application issues.
• Develop and maintain standardized credentialing and enrollment processes and workflows.
• Ensure compliance with payer requirements, regulatory standards, and organizational policies.
• Collaborate with providers, practice leadership, billing, revenue cycle, and other departments to resolve enrollment and credentialing issues.
• Track and report key metrics related to credentialing, enrollment, expirations, and payer participation.
• Identify opportunities to improve processes, reduce enrollment delays, and increase operational efficiency.
• Ensure providers remain active and properly enrolled with participating payers.
• Maintain up-to-date knowledge of payer policies, credentialing standards, and regulatory requirements.
• Provide leadership, training, and guidance to credentialing and enrollment staff.

Qualifications

Required

• Previous healthcare credentialing and provider enrollment experience is required.
• Experience working with commercial insurance payers and/or government payers, including Medicare and Medicaid.
• Strong understanding of provider credentialing, re-credentialing, and payer enrollment processes.
• Experience managing credentialing documentation, applications, expirables, and provider records.
• Strong attention to detail and organizational skills.
• Excellent communication and problem-solving abilities.
• Ability to manage multiple priorities and meet strict deadlines.
• Previous leadership or management experience preferred.
• Must be willing to work onsite in Houston, TX.

Preferred

• Experience leading a credentialing or provider enrollment department.
• Knowledge of CAQH and payer enrollment portals.
• Familiarity with NCQA credentialing standards and healthcare regulatory requirements.
• Experience with credentialing/enrollment software or healthcare information systems.
• Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.

Compensation

$80,000–$100,000 annually, based on experience and qualifications.