JOB SUMMARY
The Director, Credentialing & Payer Enablement is responsible for the strategic
leadership, performance, and continuous improvement of Baylor Genetics'
credentialing, payer enrollment, payer portal management, and payer enablement
functions. This role oversees credentialing and recredentialing activities,
Medicare, Medicaid, Tricare, and commercial payer enrollments, revalidations,
EFT/ERA implementation, payer portal administration, and new payer onboarding
readiness. The Director ensures Baylor Genetics maintains the credentials,
enrollments, and payer connectivity required to support contracting, billing,
and reimbursement operations.
This leader partners closely with Market Access, Revenue Cycle Operations,
Billing, Compliance, Finance, Technology, and third-party partners, including
Quadax, to ensure timely enrollment completion, payer readiness, and
reimbursement optimization. The ideal candidate is highly detail-oriented,
self-directed, execution-focused, and experienced navigating complex payer and
state enrollment processes while successfully escalating and resolving barriers
that impact reimbursement.
KEY RESPONSIBILITIES
Strategic Leadership & Operations
· Develop and execute the credentialing and payer enablement strategy, operating
model, and performance goals.
· Lead credentialing, payer enrollment, and portal administration teams while
driving accountability, quality, and operational excellence.
· Partner closely with Market Access to support payer implementation and
contracting readiness.
· Establish KPIs, reporting, and governance processes to drive performance and
accountability.
Credentialing & Payer Enrollment
· Oversee credentialing, recredentialing, Medicare, Medicaid, Tricare, and
commercial payer enrollment activities.
· Ensure timely completion of enrollments, revalidations, payer demographic
updates, and provider record maintenance.
· Drive improvements in enrollment turnaround times, first-pass approval rates,
and reimbursement readiness.
· Lead complex enrollment initiatives supporting new products, payers, and
business expansion efforts.
Payer Enablement & Vendor Management
· Oversee payer portal administration, EFT enrollment, ERA enrollment, claims
routing readiness, and payer onboarding activities.
· Partner with internal billing teams and third-party partners, including
Quadax, to ensure successful payer implementation and reimbursement readiness.
· Manage vendor performance, service expectations, escalations, and operational
outcomes.
· Ensure payer connectivity and billing readiness are established and maintained
across all contracted health plans.
Escalation, Compliance & Continuous Improvement
· Serve as the executive escalation point with state Medicaid agencies, Medicare
contractors, and commercial health plans to resolve enrollment barriers and
accelerate approvals.
· Ensure compliance with payer, regulatory, and organizational requirements.
· Lead process improvement initiatives, root-cause analysis, and operational
transformation efforts.
· Maintain accurate documentation, policies, procedures, and audit-ready
processes.
Leadership & Talent Development
· Develop high-performing teams and foster a culture of accountability,
execution, and continuous improvement.
· Establish clear performance expectations and quality standards.
· Hold team members accountable for productivity, accuracy, and service
commitments.
· Lead resource planning, employee development, succession planning, and
performance management activities.
QUALIFICATIONS
Education
· Bachelor's or Associate degree preferred; OR
· High School Diploma/GED with 10+ years of progressive healthcare operations
experience.
Experience
· 10+ years of experience in credentialing, provider enrollment, payer
operations, revenue cycle management, or related healthcare functions.
· 5+ years of leadership experience managing teams and operational performance.
· Extensive experience with Medicare, Medicaid, commercial payer, and Tricare
enrollment processes.
· Proven success expediting complex enrollments, revalidations, and payer
onboarding activities.
· Experience managing payer portals, EFT/ERA enrollment, and payer enablement
functions.
· Demonstrated experience working with external vendors and payer organizations
to resolve operational issues and improve outcomes.
· Diagnostic laboratory, molecular diagnostics, or healthcare provider
experience preferred.
CORE COMPETENCIES
· Credentialing & Provider Enrollment
· Medicaid & Government Program Expertise
· Payer Enablement & Portal Management
· EFT/ERA Implementation
· Vendor Management
· Problem Solving & Escalation Management
· Accountability & Execution
· Operational Excellence
· Quality & Compliance
· Data-Driven Decision Making
· Cross-Functional Leadership
· Attention to Detail
PHYSICAL DEMANDS AND WORK ENVIRONMENT
· Location: Remote
· Physical demands for the job (e.g., Must be able to lift 25 lbs, standing for
prolonged periods of time, etc.)
· Work environment required for the job duties (e.g., Exposure to laboratory
chemicals, etc.)
· Travel Requirements
· Special conditions (e.g. lab/clinical requirements if applicable)
EEO STATEMENT
Baylor Genetics is proud to be an equal opportunity employer committed to
fostering an inclusive and diverse workplace. We welcome and encourage
applicants from all backgrounds to apply. We do not discriminate on the basis of
race, color, religion, national origin, sex, sexual orientation, gender
identity, age, veteran status, disability, genetic information, pregnancy,
childbirth, or any other status protected by applicable federal, state, or local
law. If you need an accommodation during the application process, please contact
our Human Resources team.
Note to Recruiters:
We value building direct relationships with our candidates and prefer to manage
our hiring process internally. While we occasionally partner with select
recruitment agencies for specialized roles, we do not accept unsolicited resumes
from recruiters or agencies without a written agreement executed by the
authorized signatory for Baylor Genetics ("Agreement"). Any resumes submitted to
Baylor Genetics in the absence of an Agreement executed by Baylor Genetics'
authorized signatory will be considered the property of Baylor Genetics, and
Baylor Genetics will not be obligated to pay any associated recruitment fees.