Director of Payer Contracting, Network & Provider Credentialing

Department: Revenue Cycle

Employment Type: Permanent - Full Time

Location: Austin, TX

Description

Key Responsibilities

• 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.

• 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

• 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.

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!