Position Summary
The Director of Provider Credentialing provides strategic and operational leadership over all provider credentialing, privileging, and payer enrollment functions for the psychiatric hospital and affiliated outpatient, as well as supporting the HCBS operators with timeliness and organization of provider requirements with payors.
The Director serves as the primary liaison between Facility contacts to gather required provider information and submit via portal or other credentialing process. The Director also works intimately with the HCBS operators to ensure they meet their submission deadlines and do not fall out of standing with any payors.
Primary Responsibilities
1. Strategic Leadership
• Develop and oversee credentialing and privileging strategy across inpatient psychiatry, detox, rehab, outpatient, child & adolescent, and HCBS programs.
• Establish standardized credentialing policies across multiple states.
• Build scalable processes to support growth, acquisitions, and de novo site launches.
• Implement KPI dashboards and performance tracking.
2. Medical Staff Governance & Privileging
• Oversee payor privileging processes for purposes of provider billing.
• Support HCBS equivalent operations.
3. Perform Payer Enrollment for Hospital sites and Provide Oversight for HCBS
• Direct Medicare, Medicaid (multi-state), and commercial payer enrollment strategy.
• Oversee CAQH, PECOS, NPPES, and state Medicaid systems.
• Ensure timely payer revalidations and enrollment updates.
• Reduce revenue leakage caused by credentialing delays.
• Coordinate enrollment for telehealth services where applicable.
4. Team Leadership & Development
• Lead, mentor, and manage HCBS team contacts.
• Develop SOPs and training materials for redundancy and coverage.
• Oversee workload support during rapid provider onboarding within HCBS.
5. M&A / Growth Support (if applicable)
• Lead credentialing integration for acquisitions or Deno Vo.
• Conduct due diligence review of acquired provider files.
• Develop transition plans for payer alignment.
• Support rapid onboarding for expansion markets.