Credentialing & Payer Operations Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the complete lifecycle of licensing, credentialing, and re-credentialing applications for Care Team members across various states.

• Develop and implement Doula Readiness workflows to onboard non-traditional care providers into payer networks.

• Gather, audit, and validate primary source documentation for payer and state credentialing submissions.

• Engage with providers to obtain missing documentation, assist with state renewal procedures, and resolve onboarding obstacles.

• Track clinical and non-clinical staff credentials, state license expirations, BLS/CPR certifications, and CEU requirements.

• Create automated workflow reminders in Medallion for renewal deadlines and continuing education obligations.

• Review and document completion certificates for training, CEUs, and specialty accreditations.

• Establish, standardize, and enhance credentialing and payer enrollment procedures.

• Manage and uphold the Medallion credentialing management system.

• Monitor and improve operational KPIs, including Time-to-Credentialing.

• Produce performance analytics and status reports for leadership review.

• Supervise the credentialing-to-claims bridge and provider-billing system integrations.

• Submit credentialing packets to commercial insurance plans, Medicaid agencies, and managed care organizations.

• Collaborate with RCM, billing, and coding teams to address credentialing-related claims issues and enrollment delays.

• Keep track of licensure bodies, OIG exclusions, Medicaid/Medicare sanctions, and NPDB records.

• Ensure compliance with healthcare regulations, state licensing mandates, HIPAA guidelines, and payer enrollment criteria.

• Manage client-facing compliance reporting for health plan and enterprise client audits.

• Act as the primary contact for enterprise clients regarding provider panel status and credentialing timelines.

• Work closely with Implementation and Client Success teams to align provider availability with client go-live schedules.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare credentialing, provider operations, and payer enrollment.

• Proven experience in submitting initial state licensure applications across multiple states simultaneously.

• Familiarity with tracking ongoing certification and CEU requirements.

• Bachelor’s degree in Healthcare Administration, Business, or a related field; an Associate's degree will be accepted with equivalent hands-on experience.

• Strong preference for hands-on experience with Medallion or similar credentialing tracking systems.

• Exceptional project management skills.

• Capability to monitor multiple active licenses, BLS certifications, CEU deadlines, and payer files concurrently.

• Ability to work independently, resolve complex payer delays, and establish processes without an existing framework.

• Excellent verbal and written communication skills.

• Solid understanding of credentialing linkages, billing cycles, and claims reimbursement processes.

🏝️ Benefits

• Annual paid holidays.

• Unlimited time off for full-time salaried employees after the 90-day introductory period.

• Three weeks of paid time off for full-time hourly employees after the 90-day introductory period.

• Medical insurance covering hospital, surgical, and prescription drug benefits.

• Dental insurance.

• Vision insurance.

• Stock option grant.

• Life insurance.

• Short-term and long-term disability insurance.

• 401(k) retirement plan.