Director, Platform Credentialing

Job Description: Director, Platform Credentialing

Department: Revenue Cycle

Report to: Sr. Director, RCM Operations

Travel: Up to 20% as needed

Introduction

Retina Consultants of America is seeking an experienced and strategic Director of Platform Credentialing to join our Revenue Cycle leadership team. This position plays a critical role in leading and scaling RCA's enterprise credentialing and provider enrollment function across our national network of partner practices.

The Director of Platform Credentialing is a highly visible leadership role responsible for developing and executing a standardized, scalable credentialing strategy that supports provider growth, practice integrations, payer enrollment, regulatory compliance, and provider readiness. This individual will lead the Platform Credentialing team and partner closely with Revenue Cycle leadership, Compliance, Legal, physicians, practice leadership, and payer partners to ensure providers are appropriately credentialed and enrolled to support timely patient care and reimbursement.

Our Company

Retina Consultants of America (RCA) is bringing together national leaders in surgical and clinical retina care. This network comprises preeminent retina research specialists with the common goal of eradicating blindness caused by macular degeneration, diabetic retinopathy, and other retina diseases.

With over 2.3 million annual patient visits, more than 300 physicians, and over 270 locations, Retina Consultants of America (RCA) is the largest retina care provider in the nation.

Our Mission

Through RCA's physician-centered practice management model, physicians continue to drive clinical care and practice culture while benefiting from business expertise, shared resources, and best practices.

RCA seeks to expand its mission by partnering with leading retina specialists who are passionate about delivering exceptional patient care and participating in innovative research.

RCA has created a business model that enables retina specialists to retain autonomy and ownership while leveraging the strength of a national platform dedicated to operational excellence and continuous improvement.

Our Core Values

• Relentlessly Commit to our Patients, the Practices We Serve, and our Mission
• Embrace the Legacies of Our Partner Practices
• Strive for Continuous Improvement Through Education and Research
• Exude Compassion in All We Do

Position Overview

The Director of Platform Credentialing is responsible for the strategic leadership, development, and performance of RCA's enterprise credentialing and provider enrollment function.

This role oversees credentialing and enrollment activities across RCA's national network, including new provider onboarding, Medicare and Medicaid enrollment, commercial payer enrollment, recredentialing and revalidation, provider and practice demographic changes, location additions, and ongoing credentialing maintenance.

The Director will establish standardized processes, performance expectations, reporting, and escalation pathways while developing a credentialing team capable of supporting RCA's continued provider and practice growth.

A key focus of this role is provider readiness. The Director will partner across Revenue Cycle and Operations to proactively identify credentialing risks, communicate payer readiness, and minimize delays that could impact a provider's ability to see patients or bill for services.

The successful candidate is an experienced credentialing leader who combines strong provider enrollment knowledge with people leadership, operational discipline, strategic thinking, and the ability to build scalable processes within a rapidly growing organization.

Essential Duties and Responsibilities

• Provide strategic and operational leadership for RCA's Platform Credentialing and provider enrollment function.
• Lead, develop, and manage the Platform Credentialing leadership team and credentialing staff, establishing clear expectations, accountability, and performance standards.
• Develop and maintain standardized enterprise processes for provider credentialing, payer enrollment, recredentialing, revalidation, demographic changes, practice and location additions, and ongoing credential maintenance.
• Oversee provider onboarding and payer enrollment readiness, ensuring credentialing activities begin timely and potential barriers are identified and escalated proactively.
• Establish performance metrics and reporting for credentialing turnaround times, provider readiness, payer enrollment status, upcoming expirables and revalidations, team productivity, and operational risks.
• Provide Revenue Cycle and organizational leadership with clear, timely reporting on provider readiness, enrollment risks, escalations, and credentialing performance.
• Lead credentialing workstreams associated with new practice integrations, acquisitions, provider additions, new locations, and other organizational growth initiatives.
• Partner with Practice Operations, Revenue Cycle, Compliance, Legal, Finance, Systems, and practice leadership to ensure credentialing requirements are incorporated into provider and practice implementation plans.
• Establish clear escalation processes for payer delays, enrollment barriers, provider readiness concerns, and other issues that could impact reimbursement or operations.
• Maintain oversight of Medicare PECOS, state Medicaid programs, CAQH, commercial payer portals, and other credentialing and enrollment systems.
• Lead the continued development, adoption, and optimization of Modio OneView and other credentialing technology across RCA.
• Ensure credentialing systems and workflows provide accurate visibility into enrollment status, expirables, revalidations, provider records, and outstanding requirements.
• Identify opportunities to improve credentialing performance through standardization, automation, technology, reporting, and workflow redesign.
• Develop and maintain credentialing policies, procedures, standard operating procedures, reference materials, and documentation standards.
• Ensure appropriate processes are maintained to support regulatory, payer, and organizational credentialing requirements.
• Monitor credentialing performance and trends to identify operational risks, recurring barriers, resource needs, and opportunities for improvement.
• Build team capacity and organizational structure to support RCA's continued growth in physicians, practices, locations, and payer enrollment volume.
• Develop credentialing leaders and team members through coaching, training, delegation, performance management, and succession planning.
• Serve as a credentialing and provider enrollment resource for Revenue Cycle leadership, practice leadership, physicians, and other organizational stakeholders.
• Foster a culture of accountability, proactive communication, collaboration, continuous improvement, and operational excellence.
• Perform other duties and strategic initiatives as assigned by Revenue Cycle leadership.

Knowledge, Skills, and Abilities

• Extensive knowledge of healthcare credentialing and provider enrollment within a multi-site physician organization.
• Strong working knowledge of Medicare, Medicaid, and commercial payer enrollment requirements and processes.
• Experience with CAQH, PECOS, state Medicaid enrollment systems, commercial payer portals, and credentialing technology platforms.
• Strong understanding of provider onboarding, payer enrollment, recredentialing, revalidation, expirables, demographic changes, location additions, and group/provider enrollment structures.
• Demonstrated ability to build, standardize, and scale credentialing operations across multiple practices, states, or markets.
• Strong people leadership skills with experience managing and developing credentialing teams and leaders.
• Ability to establish meaningful KPIs, analyze credentialing performance, identify risks, and communicate actionable information to senior leadership.
• Experience navigating complex credentialing scenarios, including FMGs, cross-state enrollment, non-board-certified providers, and providers without Social Security Numbers.
• Strong project management and organizational skills with the ability to manage multiple provider, payer, and practice priorities simultaneously.
• Ability to effectively manage payer escalations and complex credentialing or enrollment issues.
• Strong written and verbal communication skills with the ability to communicate complex credentialing issues clearly to physicians, practice leaders, and executive stakeholders.
• Demonstrated ability to collaborate across Revenue Cycle, Operations, Compliance, Legal, Finance, IT/Systems, and practice leadership.
• Strong judgment, attention to detail, accountability, and follow-through.
• Ability to operate effectively in a fast-paced, rapidly growing organization.
• Proficiency with credentialing and provider enrollment technology, including Modio OneView or similar credentialing platforms, with the ability to leverage technology for workflow management, reporting, expirables, revalidations, and provider enrollment visibility.
• Proficiency with Microsoft Office Suite and experience using reporting and analytics tools to monitor operational performance.
• Ability to travel as needed.

Education and Experience

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
• Minimum of seven (7) years of progressive healthcare credentialing and/or provider enrollment experience.
• Minimum of five (5) years of leadership experience, including responsibility for leading and developing teams.
• Experience leading credentialing or provider enrollment operations within a multi-site physician group, management services organization (MSO), health system, or similarly complex healthcare organization strongly preferred.
• Experience supporting Medicare, Medicaid, and commercial payer enrollment across multiple states strongly preferred.
• Experience developing standardized credentialing processes, performance metrics, and scalable operating models preferred.
• Experience implementing, optimizing, or managing credentialing technology platforms such as Modio OneView or similar systems preferred.
• CPCS and/or CPMSM certification preferred.
• Ophthalmology, retina, or specialty physician practice experience preferred.

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

Work Location: Remote