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About the Role

The Director of Payer Contracting, Network & Provider Credentialing leads Aspire Allergy & Sinus’s payer contracting and network strategy. This role is accountable for the provider credentialing and enrollment function, determining payer products and networks that support patient access and financial performance, directing contract negotiations and reimbursement strategy, and establishing standards for provider readiness to practice and bill.

Responsibilities

• Develop and lead the enterprise payer contracting, network participation, reimbursement, and provider credentialing strategy.
• Evaluate payer and product participation based on 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.
• Develop rate and fee schedule strategies, analyzing 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 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.
• 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.
• Define decision rights and handoffs among Payer Contracting, Credentialing, Revenue Cycle Management, Operations, Finance, and other partners.
• Present executive updates 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.

Requirements

• Three to five years of leading people or a major function.
• 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.
• Periodic travel to clinics, payer meetings, acquisitions, audits, and leadership events is required, generally up to 15%.

Skills

• 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.
• 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.

Location

• Austin, TX

Work Type

• Permanent - Full Time
• Onsite

Experience Level

• Director

Education Level

• Bachelor’s degree in healthcare administration, business, finance, management, or a related field; equivalent relevant experience may be considered.

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

About the Company

• Aspire Allergy & Sinus