Director of Contracting & Credentialing at SOUTH COAST COMMUNITY SERVICES

Mission Viejo, California, United States -

Full Time

Start Date

Immediate

Expiry Date

25 Jun, 26

Salary

165000.0

Posted On

27 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing, Contracting, Payer Enrollment, Managed Care, CAQH, Availity, PAVE, Directory Accuracy, Contract Tracking, Compliance, Audit Readiness, Leadership, System Maintenance, Provider Relations, Medi-Cal Systems, Risk Management

Industry

Mental Health Care

Description

Description POSITION SUMMARY: The Director of Contracting & Credentialing provides leadership and oversight to ensure SCCS’s providers, services, and organizational entities are accurately credentialed, enrolled, and represented across commercial payers, managed care organizations, and County Medi-Cal systems as the organization expands across multiple states. Reporting to the Chief Marketing & Development Officer, with a dotted line to the CFO, this role serves as the central authority for credentialing, enrollment, directory accuracy, payer system integrity, and contract tracking. The Director brings established relationships with senior leaders across commercial insurers, MCOs, and County Medi-Cal and ensures continuity, accuracy, and accountability in all contracting and credentialing-related activities. Requirements GENERAL REQUIREMENTS: Education/Experience Bachelor’s degree required; Master’s preferred. 8–10+ years of progressive experience in provider credentialing, payer enrollment, and managed care environments. Demonstrated experience leading credentialing functions and performing hands-on credentialing work. Strong working knowledge of CAQH, Availity, PAVE, and payer and MCO portals. Experience supporting multi-state healthcare organizations. Established professional relationships with senior leaders across commercial payers, managed care organizations, and County Medi-Cal systems. Licensure, Registration, Certification Valid CA driver’s license and proof of automobile insurance. Credentialing certification such as CPCS or CPMSM, preferred. Experience in behavioral health or community-based healthcare settings, preferred. Experience building and maintaining contract and credentialing tracking systems, preferred. JOB DUTIES & RESPONSIBILITIES: Credentialing & Re-credentialing Leadership Lead and perform credentialing and re-credentialing for providers and applicable organizational entities, ensuring complete, accurate, and compliant credentialing files. Oversee primary source verification, licensure and certification monitoring, sanction checks, and credentialing documentation standards. Prepare for and manage credentialing audits, delegated oversight reviews, and corrective action plans. Establish credentialing timelines, quality benchmarks, and audit readiness standards. Enrollment, Portals & System Accuracy Maintain payer, MCO, and governmental enrollment platforms, including CAQH, Availity, PAVE (Provider Application and Validation for Enrollment), and state- or payer-specific portals. Ensure systems reflect accurate provider, service, location, and scope-of-practice information. Track enrollment status, revalidations, expirations, and required updates to support timely activation and uninterrupted reimbursement. Serve as the organizational expert on payer, MCO, and governmental portal requirements across markets and states. Provider Directories & Representation Accuracy Ensure provider directories and rosters are current, accurate, and aligned with contracted services and locations. Conduct regular audits of directory submissions and reconcile discrepancies. Collaborate with internal partners to resolve issues affecting directory accuracy and network representation. Contract Tracking & Strategic Visibility Maintain a centralized system to track all payer and MCO contracts, including effective dates, term lengths, amendment history, credentialing-related requirements, and notification provisions for new service offerings. Track and flag contract milestones, including required notice periods for adding services, two-year or contract-defined rate review and renegotiation windows, and renewal and termination notice deadlines. Provide leadership with timely, accurate visibility into contractual obligations and opportunities. Payer & County Relationship Stewardship Maintain and strengthen established, long-standing relationships with senior leaders across commercial payers, managed care organizations, and County Medi-Cal entities. Serve as a consistent point of continuity as payer and county leadership evolves. Coordinate and support payer and county meetings in alignment with organizational priorities. Governance, Audit Readiness & Risk Management Serve as SCCS’s authority on credentialing, enrollment, directory, and contract-related compliance requirements. Collaborate with Finance and Compliance to ensure readiness for audits, reviews, and monitoring activities. Identify risks related to credentialing gaps, inaccurate directories, or missed contractual requirements and implement corrective measures. Systems, Documentation & Team Leadership Design and maintain scalable systems to track credentialing status, enrollments, directories, and contract milestones. Develop and maintain SOPs, workflows, and documentation standards. Lead, train, and mentor credentialing staff and external partne

Responsibilities

This role provides leadership and oversight for ensuring providers and organizational entities are accurately credentialed, enrolled, and represented across various payer systems, serving as the central authority for credentialing, enrollment, directory accuracy, and contract tracking. Key duties include leading credentialing/re-credentialing, maintaining payer enrollment platforms, ensuring provider directory accuracy, and managing contract tracking systems.