Description

POSITION PURPOSE:

The Director of Credentialing and Contracting is responsible for leading and managing credentialing, re-credentialing, and contracting activities for partner practice and surgeons. This role ensures compliance with regulatory requirements, payer policies, and organizational standards while fostering strong relationships with payers, providers, and stakeholders. The Director plays a pivotal role in development, adoption, and execution of payer strategy, in support of USOSM’s organic growth initiatives. 

PRINCIPAL RESPONSIBILITIES AND DUTIES:

1. Credentialing Management:
   • Oversee the credentialing and re-credentialing processes for providers to meet the standards of payers, accreditation bodies, and regulatory agencies.
   • Develop, implement, and maintain credentialing policies and procedures.
   • Ensure all providers are enrolled with contracted health plans and government payers in a timely manner.
   • Support enrollment initiatives to support associate ramp and other organic growth objectives.
   • Collaborate with compliance teams to ensure alignment with legal and regulatory requirements, including NCQA, CMS, and Joint Commission standards.
2. Contract Negotiation and Management:
   • Oversee contract and rate negotiation process with payers, vendors, and other stakeholders. Presentation of proposed and current strategy to partner surgeons, field operations, and other functional owners.
   • Review and analyze contract terms to ensure alignment with organizational goals and compliance standards.
   • Monitor contract renewals, amendments, and termination timelines to ensure appropriate efficient and timely renegotiation efforts.
   • Help develop and support national or market-based payer strategies (participation, reimbursement).
   • Handle escalations regarding contract negotiations and issue resolution.
   • Conduct financial and operational analysis of payer contracts to optimize reimbursement rates and terms, including Business Analyst functions, processes, and technology to ensure optimal use of internal and external data sources to guide decision-making.
3. Market, Payer Rate, and Coding Compliance:
   • Develop, present, and ensure implementation of practice fee reviews/increases at partnership and annually thereafter.
   • Support cross-departmental efforts to track, aggregate, and analyze payer rate nonconformance. Help define strategy to address nonconformance and/or remediation through payer relationships.
   • Oversee execution of clinical coding initiatives to drive accurate and appropriate clinical coding. Facilitate provider education and training; analysis of code utilization; best practice adoption.
4. Leadership and Team Oversight:
   • Supervise and guide the credentialing and contracting team, providing training, support, and performance evaluations.
   • Create and implement strategic plans to improve efficiency
5. Process Improvement & Standardization:
   • Develop, document, and refine credentialing and payer contracting processes, focusing on accuracy, efficiency, and scalability.
   • Create strategies to standardize, sustain, and scale processes and deliverables to support organizational growth.
6. Reporting & Documentation:
   • Maintain detailed documentation of standard operating procedures and KPI tracking.
   • Deliver comprehensive reporting to surgeons, stakeholders, and executive leadership, supporting transparency and strategic decision-making.
7. Additional Duties:
   • Performing any additional duties as needed.

MINIMUM QUALIFICATIONS:

• Leadership: Strategic, collaborative leader who can align teams and inspire trust among surgeons.
• Detail Orientation: High attention to accuracy and thoroughness in rate analysis and data integrity.
• Problem Solver: Proactive in addressing data discrepancies, process improvements.
• Physician-Facing: Skilled in fostering trusting relationships with surgeons, with a strong focus on clear and transparent communication.
• Mastery of Excel, Power BI, Domo, and Ad Hoc reporting.
• Ability to answer and manage emails, questions and responses to the group email and/or ticketing system.
• Ability to format data into presentable visualizations and support executive team in transforming data into presentable and stakeholder-facing format.
• Communication: Ability to be on camera and support senior executive leadership in identifying, trending, and remediating payer, industry, and process-related challenges.
• Attention to detail while meeting deadlines with accuracy.
• Accountability for work product and taking ownership.
• Openness to feedback: Proactively seeks feedback, admits mistakes, and is open to criticism.
• Consistency: Following through, being direct, truthful, and consistent.
• Legal knowledge: Compliance w/ HIPAA and healthcare data and confidentiality requirements.
• Ability to travel

Previous Experience/Education:

• Education: Bachelor’s degree in business, finance, healthcare administration or related field; Master’s degree preferred.
• 7 years in dental payer contracting, credentialing, or related fields with progressive growth in management of large teams within payer or provider-side organizations.
• Proven experience with contract interpretation, negotiation, and compliance. Ability to operationalize contractual terms and apply to reimbursement scenarios.
• Strong understanding of the credentialing and payer enrollment process, data management, regulatory/compliance environment. Focus on best-in-class process and technology-driven solutions to promote efficiency, accuracy, and high provider satisfaction.
• Familiarity with MSO/DSO model with a focus on client/customer service.
• Expertise with rate negotiation process flows, analytics to drive optimal models for assessing and tracking impact of rate improvements.
• Excellent communication skills, particularly in translating complex credentialing and contracting concepts for provider audiences. Ability to speak to multiple audiences including field operations, staff, and senior leadership team members.
• Collaborative, solutions-oriented mindset with experience leading cross-functional initiatives.

PHYSICAL REQUIREMENTS

• While performing the duties of this job, the employee is regularly required to sit for prolonged periods. Occasional lifting and bending to carry boxes and supplies, up to 25 pounds, may be required.

By joining US Oral Surgery Management (USOSM), you become part of a dynamic and forward-thinking organization made up of best-in-class Oral and Maxillofacial practices. Together, we have the POWER to achieve more, by creating a positive impact on the communities we serve and reinforcing our position as a top leader in the industry. We believe in the POWER of teamwork, where every member contributes to our collective success. Whether you're in clinical operations, administration, support services, etc., your role is crucial to achieving our shared mission: fueling innovation and clinical excellence, while driving worthwhile outcomes for our practices.

Our POWER Values form the foundation of our ability to deliver exceptional healthcare experiences and achieve sustainable growth.

Passion for Patient Care

Outstanding Results

Winning Attitude

Embracing Continuous Improvement

Respect for Self and Others

Please note, this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications

Salary : $135,000 - $150,000