OverviewThe Director of Payor Credentialing provides strategic and operational leadership for the enterprise payer enrollment function across all UF Health markets. This leader is accountable for ensuring billing readiness by owning the full lifecycle of billing enrollment activities, including Medicare and Medicaid enrollment, commercial payer enrollment, EFT/ERA setup, CMS 855 submissions, payer portal enrollments, and revalidations. The Director maintains a close, collaborative relationship with the Medical Staff Office, which retains responsibility for provider credentialing, ensuring seamless coordination between credentialing approvals and enrollment execution. Looking forward, this leader will partner with and support the organization's long-term Centralized Verification Organization (CVO) strategy, supported by a single, standardized enrollment and verification system that eliminates redundancy, reduces enrollment lag and denials, and improves data integrity across all entities. This role is a critical partner to RCM operations, Finance, Managed Care, Compliance, and provider onboarding teams across UF Health.
QualificationsEducation- Bachelor's degree in health administration, Business, Health Informatics, or a related field required.
Experience- Minimum of 7 years of progressive experience in healthcare payer enrollment, provider credentialing, or revenue cycle operations, with at least 3 years in a leadership or management role.
License/Certification/Registration- Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) through NAMSS preferred.
Other Qualifications- Demonstrated expertise in Medicare and Medicaid enrollment processes, including CMS 855 submissions, PECOS, revalidations, and state Medicaid portal enrollment.
- Proven experience managing commercial payer enrollment and EFT/ERA setup across a large, multi-specialty, multi-market provider enterprise.
- Experience managing enterprise-level enrollment tracking systems with accountability for billing readiness reporting.
- Demonstrated ability to collaborate effectively with a Medical Staff Office or credentialing functions within a large health system, with clear understanding of the distinction between provider credentialing and payer enrollment.
- Experience with or exposure to CVO model development or enrollment centralization initiatives strongly preferred.
- Familiarity with Epic provider enrollment and credentialing modules preferred.
- Strong knowledge of provider enrollment compliance requirements, including CAQH, NPI registry management, and payer-specific credentialing requirements.
