Vice President, Payer Contracting & Credentialing

Vice President, Payer Contracting & Credentialing

$200000 - $230000 per year | Windy Hills, KY | Remote | Permanent

Vice President, Payer Contracting & Credentialing/$$$/Drive technology-enabled business optimization!!

A bit about us:

Our client fast-growing healthcare services and value-based care organization that partners with physician groups and health systems nationwide to improve operational performance, revenue outcomes, and patient care.

Why join us?

• TOP COMPENSATION & BONUS • REMOTE with travel • Full Benefits package • Retirement • CTO

Job Details

Job Details

Lead the strategy. Strengthen payer partnerships. Build the infrastructure that helps providers deliver exceptional care.

We are seeking a permanent Vice President, Payer Contracting & Credentialing to drive payer contracting performance and operational excellence across a growing healthcare organization. This executive leadership opportunity combines complex negotiations, value-based and risk-based contracting, and oversight of payer enrollment and credentialing in a multi-site, multi-state environment.

You will connect contracting strategy with operational execution, helping expand network participation, protect reimbursement, accelerate provider readiness, and support sustainable growth. Partnering with clinical, finance, revenue cycle, compliance, and operations leaders, you will build scalable processes that deliver measurable results.

Responsibilities

Lead enterprise payer contracting strategy, including payer negotiations, contract renewals, reimbursement improvements, and network participation initiatives.

Develop and negotiate fee-for-service, value-based contracting, and risk-based contracting arrangements aligned with organizational capabilities, financial goals, and patient care priorities.

Partner with finance and analytics teams on contract modeling, reimbursement analysis, scenario planning, and evaluation of financial and operational risk.

Oversee payer enrollment, provider enrollment, credentialing, re-credentialing, and delegated credentialing to support timely provider participation and continuity of reimbursement.

Establish credentialing policies, controls, and audit readiness practices aligned with applicable NCQA standards, payer requirements, and regulatory obligations.

Direct accurate, timely maintenance of CAQH profiles, PECOS records, enrollment applications, and supporting provider documentation.

Strengthen roster management and provider data management across payer networks, internal systems, and organizational entities.

Implement and optimize a contract management system to track agreements, obligations, renewal dates, reimbursement terms, and performance commitments.

Build scalable workflows for onboarding providers, opening new sites, entering new states, and integrating acquired physician groups or MSO-supported practices.

Track and improve key performance indicators, including enrollment turnaround times, credentialing cycle times, roster accuracy, contract performance, and payer-related reimbursement barriers.

Use process improvement and root cause analysis to resolve recurring issues, reduce administrative delays, and strengthen accountability across teams.

Build, coach, and lead high-performing teams while establishing clear priorities, service standards, and development opportunities.

Serve as an executive escalation point for payer disputes, enrollment barriers, credentialing concerns, and complex contracting matters.

Qualifications

10+ years of progressive experience in healthcare payer contracting, enrollment, credentialing, or related leadership roles, with demonstrated responsibility for strategic initiatives and operational results.

Proven success leading payer negotiations and evaluating reimbursement terms, contract provisions, and network participation opportunities.

Experience with value-based contracting and risk-based contracting, including assessment of financial exposure, performance requirements, and operational readiness.

Strong knowledge of payer enrollment, provider enrollment, credentialing, re-credentialing, and delegated credentialing.

Hands-on familiarity with CAQH, PECOS, applicable NCQA standards, roster management, and provider data management.

Experience using contract modeling and a contract management system to inform decisions and manage the contract lifecycle.

Experience supporting a multi-site, multi-state healthcare organization, MSO, physician group, or comparable provider organization.

Demonstrated ability to lead process improvement, conduct root cause analysis, and implement sustainable solutions.

Strong financial and analytical skills, with the ability to translate complex contracting and operational information into clear executive recommendations.

Excellent negotiation, communication, relationship management, and cross-functional leadership skills.

Ability to build effective teams, manage competing priorities, and deliver results in a dynamic healthcare environment.

Equivalent combinations of relevant experience, skills, and demonstrated achievement will be considered.

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