Director of Credentialing

Director of Credentialing

Department: Revenue Cycle

Employment Type: Permanent - Full Time

Location: Austin, TX

The Director of Credentialing provides strategic leadership and oversight for provider credentialing, payer enrollment and maintenance, professional liability administration, regulatory compliance, and credentialing readiness across Aspire Allergy & Sinus. This leader develops and implements the processes, service standards, technology, reporting, and team structure needed to support our growing, multi-state specialty healthcare organization.

The Director leads the Credentialing Manager and credentialing team while collaborating closely with Revenue Cycle Management, Payer Contracting, Human Resources, Talent Acquisition, Legal and Compliance, Operations, Clinical Leadership, Information Technology, Finance, providers, payers, and external partners.

This role is essential to protecting patient access and organizational revenue by ensuring providers are credentialed and enrolled accurately and efficiently. The Director ensures complete provider records, verified payer effective dates, accurate system configuration, appropriate professional liability coverage, and audit-ready documentation.

This position requires full-time onsite work at our HQ location at 5929 Balcones Dr, Austin, TX 78731.

Essential Functions:

• Develop and maintain the enterprise credentialing strategy, operating model, policies, procedures, staffing plan, service standards, controls, training, and annual priorities.
• Define responsibilities, decision rights, handoffs, and escalation paths across the Director, Manager, and Specialist levels and all cross-functional partners.
• Oversee initial credentialing, recredentialing, primary-source verification, licensure, education and training, work history, references, board certification, DEA and controlled-substance registrations, and other required qualifications.
• Ensure providers are appropriately credentialed, appointed, enrolled, revalidated, and, when applicable, privileged with health plans, hospitals, and patient care facilities under approved policies and applicable requirements.
• Direct enrollment and maintenance for Medicare, Medicaid and managed Medicaid, commercial payers, Medicare Advantage, TRICARE or VA networks, and other contracted programs.
• Oversee group and individual enrollment, reassignment, roster submission, revalidation, demographic maintenance, location and entity additions, EFT and ERA setup, ownership disclosures, and documented effective-date confirmation.
• Ensure applications and system records reflect the correct provider, group NPI, TIN, legal entity, service location, taxonomy, specialty, participation status, and billing relationships.
• Maintain governance over CAQH, NPPES, PECOS, state Medicaid systems, payer portals, credentialing platforms, provider master data, and supporting documentation.
• Establish complete, current, signed, secure, and audit-ready provider files, including documentation of discrepancies, exceptions, approvals, and corrective action.
• Oversee exclusion, sanction, licensure, and adverse-action monitoring through applicable federal, state, payer, and licensing sources, including OIG LEIE, SAM, NPDB processes where authorized, and state licensing boards.
• Lead delegated credentialing readiness and ongoing compliance, including file audits, committee materials, corrective-action plans, reporting, and payer or accreditation reviews where applicable.
• Own the administrative process for professional liability coverage in partnership with Finance, Legal, Human Resources, insurance brokers, carriers, and providers.
• Maintain accurate provider and entity insurance schedules, certificates of insurance, limits, policy periods,…