Location: Remote
Department: Revenue Cycle Management
Reports To: Senior Vice President, Revenue Cycle Management
Already Autism Health is a rapidly growing, multi-state provider of Applied Behavior Analysis (ABA) therapy and autism diagnostic services committed to improving the lives of children and families. As we continue to expand into new markets, we remain focused on delivering exceptional clinical outcomes, increasing access to care, and building a best-in-class experience for our patients, providers, and team members.
We are seeking a strategic, results-driven Director of Credentialing & Payer Contracting to lead our credentialing, provider enrollment, and payer contracting functions. This is a unique opportunity to build scalable systems, strengthen payer partnerships, and directly influence the organization's operational success and long-term growth.
The Director of Credentialing & Payer Contracting is responsible for developing and leading the organization's credentialing, payer enrollment, and managed care contracting strategy across multiple states. This executive-level leader will ensure providers and facilities are credentialed efficiently, optimize payer participation and reimbursement, maintain regulatory compliance, and develop scalable operational processes that support continued expansion.
Working closely with Executive Leadership, Revenue Cycle Management, Clinical Operations, Finance, and Talent Acquisition, this position plays a critical role in accelerating provider onboarding, improving patient access, maximizing revenue opportunities, and supporting new clinic openings and market expansion.
Lead the organization's provider, group, and facility credentialing operations while developing standardized, scalable processes that support a rapidly growing healthcare organization.
Responsibilities include:
Lead all provider, group, and facility credentialing and enrollment activities across multiple states.
Oversee credentialing and recredentialing for BCBAs, BCaBAs, Licensed Psychologists, Diagnosticians, and other credentialed providers.
Ensure timely enrollment with commercial insurance plans, Medicaid, Medicare (where applicable), and governmental programs.
Manage CAQH profiles, NPI records, PECOS registrations, state licensure tracking, and payer enrollment requirements.
Develop standardized credentialing workflows that improve efficiency and reduce provider onboarding timelines.
Establish key performance indicators (KPIs) and monitor credentialing performance to minimize delays affecting patient access and revenue.
Partner with Clinical Operations and Talent Acquisition to ensure providers are credentialed and ready to serve patients as quickly as possible.
Maintain audit-ready documentation and support accreditation reviews and regulatory inspections.
Develop and execute contracting strategies that strengthen payer relationships, expand network participation, improve reimbursement, and support organizational growth.
Responsibilities include:
Lead negotiations with commercial health plans, Medicaid Managed Care Organizations, and other payer partners.
Develop contracting strategies that support expansion into new markets and improve financial performance.
Evaluate reimbursement methodologies, fee schedules, contract amendments, and policy changes.
Perform financial and reimbursement analyses to support strategic contracting decisions.
Maintain contract inventory, renewal schedules, and contract management systems.
Collaborate with Revenue Cycle teams to resolve denials, underpayments, authorization challenges, and payer operational issues.
Monitor payer performance and identify opportunities to improve reimbursement and operational efficiency.
Support new clinic openings, acquisitions, and market expansion through strategic payer network participation.
Provide visionary leadership while building a high-performing credentialing and contracting department capable of supporting a rapidly expanding healthcare organization.
Responsibilities include:
Recruit, mentor, and develop a high-performing credentialing and contracting team.
Establish department goals, performance expectations, and accountability measures.
Develop executive dashboards and reporting that provide visibility into credentialing, enrollment, and contracting performance.
Lead continuous process improvement initiatives that reduce revenue leakage and improve operational efficiency.
Identify automation opportunities and scalable solutions that support organizational growth.
Serve as the organization's subject matter expert on credentialing, enrollment, and payer contracting.
Partner with executive leadership to align credentialing and contracting strategies with organizational objectives.
Collaborate cross-functionally with Clinical Operations, Revenue Cycle, Finance, Compliance, and Talent Acquisition to support provider recruitment, patient access, and strategic growth initiatives.
Ensure the organization remains compliant with all regulatory, accreditation, and payer requirements while proactively identifying operational and financial risks.
Responsibilities include:
Ensure compliance with federal, state, payer, accreditation, and organizational requirements.
Monitor regulatory and payer changes impacting credentialing, enrollment, reimbursement, and contracting.
Develop and maintain policies and procedures supporting compliance and operational excellence.
Ensure readiness for payer audits and accreditation reviews.
Identify operational risks and implement corrective actions that minimize financial exposure and support sustainable growth.
Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field.
Minimum of 7 years of healthcare credentialing, provider enrollment, and payer contracting experience.
Minimum of 3 years of leadership experience managing credentialing, enrollment, or contracting teams.
Demonstrated success supporting multi-site, multi-state healthcare organizations.
Extensive knowledge of commercial insurance, Medicaid managed care, provider enrollment processes, and healthcare regulations.
Proven experience negotiating and managing payer contracts.
Strong understanding of revenue cycle management and the financial impact of credentialing and contracting activities.
Experience utilizing credentialing software, contract management systems, and healthcare practice management platforms.
Excellent leadership, communication, negotiation, project management, analytical, and organizational skills.
Experience within ABA therapy, autism services, behavioral health, pediatric healthcare, or another specialty healthcare environment.
CPCS (Certified Provider Credentialing Specialist) and/or CPMSM (Certified Professional Medical Services Management) certification.
Experience supporting de novo clinic launches, acquisitions, or healthcare integrations.
Advanced reimbursement modeling and financial analysis experience.
Experience working within a high-growth, private equity-backed healthcare organization.
This is more than a credentialing leadership role—it's an opportunity to shape the infrastructure that supports access to care for thousands of children and families.
As Director of Credentialing & Payer Contracting, you will play a key role in expanding provider networks, accelerating clinic growth, strengthening payer relationships, and building scalable operational processes that directly impact patient access and organizational performance.
We offer:
Competitive compensation
Comprehensive medical, dental, and vision benefits
Paid Time Off (PTO) and company-paid holidays
401(k) with company match (where applicable)
Company-paid life insurance
Professional development and leadership growth opportunities
Fully remote work environment
A collaborative, mission-driven culture focused on innovation and continuous improvement
If you are a strategic healthcare leader who enjoys building high-performing teams, optimizing complex operational processes, and driving organizational growth, we encourage you to apply.
Already Autism Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive workplace for all employees. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, genetic information, or any other protected characteristic under applicable law.
Disclaimer: This job description is intended to convey information essential to understanding the scope of this position. It is not intended to be an exhaustive list of qualifications, responsibilities, or duties. Responsibilities may change as business needs evolve.
