Eye Health America
Director of Credentialing and Payer Relationship Management
Eye Health America, Easley, South Carolina, United States, 29640
Director of Credentialing and Payer Relationship Management
Eye Health America is a rapidly growing, multi-state eye care platform with over 150 providers, 60 clinic locations, and 15 ambulatory surgery centers (ASCs). Our mission is to deliver the highest quality personalized eye care to patients across the Southeast through a collaborative network of ophthalmologists, optometrists, and surgical specialists. We are seeking a strategic and experienced Director of Credentialing and Payer Relationship Management to lead critical infrastructure supporting our provider operations and payer engagement. Responsibilities
Oversee the end-to-end provider credentialing and re-credentialing process for 160+ providers across multiple states. Manage and optimize use of credentialing software platforms (Modio, CAQH, PECOS) to ensure compliance, accuracy, and efficiency. Ensure compliance with state and federal regulations as well as payer-specific requirements. Lead a credentialing team responsible for data integrity, provider file maintenance, and payer enrollment submissions. Develop and maintain a comprehensive dashboard to track credentialing timelines and performance KPIs. Payer Contracting & Relationship Management
Lead negotiation, renegotiation, and implementation of payer contracts in collaboration with revenue cycle and legal teams. Build and maintain strong relationships with commercial and government payer representatives to enhance contract performance and resolve escalations. Analyze payer mix, reimbursement trends, and performance metrics to support strategic decisions. Serve as a liaison between payers and internal stakeholders including billing, clinical, and operations teams. Strategic Leadership & Collaboration
Partner with executive leadership to identify new payer opportunities and support growth into new markets. Provide regular reporting on credentialing status and contract performance, including rate improvement opportunities and provider onboarding risks. Ensure integration of newly acquired practices into credentialing and payer systems seamlessly. What We Offer
Competitive compensation and performance incentives Comprehensive benefits including medical, dental, vision, and 401(k) Career growth opportunities within a fast-growing healthcare platform A collaborative and mission-driven culture focused on delivering exceptional patient care Requirements
Bachelor’s degree required; Master’s degree in healthcare administration, business, or related field preferred. Minimum 7 years of experience in healthcare credentialing and payer contracting, with 3+ years in a leadership role. Experience working in a multi-specialty or surgical group practice, ideally within eye care or a similar high-volume specialty. Proficient in credentialing software (Modio, OneApp, CAQH) and Medicare/Medicaid portals. Demonstrated success in payer contract negotiations and rate analysis. Strong organizational, interpersonal, and communication skills. Ability to lead and mentor a high-performing credentialing and contracting team. Seniority level
Director Employment type
Full-time Job function
Business Development and Sales Industries
Medical Practices
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Eye Health America is a rapidly growing, multi-state eye care platform with over 150 providers, 60 clinic locations, and 15 ambulatory surgery centers (ASCs). Our mission is to deliver the highest quality personalized eye care to patients across the Southeast through a collaborative network of ophthalmologists, optometrists, and surgical specialists. We are seeking a strategic and experienced Director of Credentialing and Payer Relationship Management to lead critical infrastructure supporting our provider operations and payer engagement. Responsibilities
Oversee the end-to-end provider credentialing and re-credentialing process for 160+ providers across multiple states. Manage and optimize use of credentialing software platforms (Modio, CAQH, PECOS) to ensure compliance, accuracy, and efficiency. Ensure compliance with state and federal regulations as well as payer-specific requirements. Lead a credentialing team responsible for data integrity, provider file maintenance, and payer enrollment submissions. Develop and maintain a comprehensive dashboard to track credentialing timelines and performance KPIs. Payer Contracting & Relationship Management
Lead negotiation, renegotiation, and implementation of payer contracts in collaboration with revenue cycle and legal teams. Build and maintain strong relationships with commercial and government payer representatives to enhance contract performance and resolve escalations. Analyze payer mix, reimbursement trends, and performance metrics to support strategic decisions. Serve as a liaison between payers and internal stakeholders including billing, clinical, and operations teams. Strategic Leadership & Collaboration
Partner with executive leadership to identify new payer opportunities and support growth into new markets. Provide regular reporting on credentialing status and contract performance, including rate improvement opportunities and provider onboarding risks. Ensure integration of newly acquired practices into credentialing and payer systems seamlessly. What We Offer
Competitive compensation and performance incentives Comprehensive benefits including medical, dental, vision, and 401(k) Career growth opportunities within a fast-growing healthcare platform A collaborative and mission-driven culture focused on delivering exceptional patient care Requirements
Bachelor’s degree required; Master’s degree in healthcare administration, business, or related field preferred. Minimum 7 years of experience in healthcare credentialing and payer contracting, with 3+ years in a leadership role. Experience working in a multi-specialty or surgical group practice, ideally within eye care or a similar high-volume specialty. Proficient in credentialing software (Modio, OneApp, CAQH) and Medicare/Medicaid portals. Demonstrated success in payer contract negotiations and rate analysis. Strong organizational, interpersonal, and communication skills. Ability to lead and mentor a high-performing credentialing and contracting team. Seniority level
Director Employment type
Full-time Job function
Business Development and Sales Industries
Medical Practices
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