Manager, Credentialing & Payer Operations

This is a fully remote position, open to applicants in New York, +1 more state.

📋 Description

• Develop and enhance systems to guarantee that providers are credentialed promptly and in accordance with regulations.

• Automate and refine credentialing workflows to provide a swift, high-quality experience for providers.

• Oversee the Credentialing Committee and collaborate with clinical leadership to implement guidelines and review documentation.

• Manage provider application processes.

• Cultivate relationships with credentialing/CVO vendors and assess and enhance SLA performance.

• Maintain and manage provider data architecture that supports credentialing and licensing requirements at scale.

• Act as a subject matter expert for provider enrollments with health plans.

• Establish relationships with key payer contacts and document and standardize enrollment processes/SOPs.

• Create quality controls and error-checking measures to minimize rework and application rejections.

• Ensure thorough documentation by the team.

• Monitor team performance and SLAs, identify aging items, and address root-cause issues.

• Mentor and lead both US-based and international specialists.

• Collaborate with RCM, payer strategy, and business development teams on payer, claims, and national expansion matters.

• Train new team members.

• Establish and uphold team performance standards.

• Work with product, engineering, and other teams to create automation and AI-driven workflows.

⛳️ Requirements

• 5+ years of experience in high-growth operations, preferably with direct involvement in provider credentialing, licensing, and payer enrollment.

• Proven ability to develop and enhance operational systems in a dynamic, resource-limited environment.

• Highly process-oriented and detail-focused.

• Strong analytical capabilities: proficient in data extraction, trend identification, and converting insights into operational strategies.

• Excellent communicator across functions, capable of driving initiatives forward without direct authority.

• Passionate about automation, tooling, and AI technologies.

• Experience in telehealth or operations involving multi-state provider networks is preferred.

• Practical experience with payer portals and third-party platforms, such as Availity, is preferred.

• Familiarity with commercial payer requirements is preferred; understanding of Medicare and Medicaid processes is advantageous.

• Background in multi-state telehealth, digital health, or a rapidly growing healthcare environment is preferred.

• Knowledge of credentialing standards like NCQA and CMS is preferred.

🏝️ Benefits

• Equity.

• Professional development and employee learning programs.

• Comprehensive health benefits, including medical, dental, and vision coverage.

• Unlimited PTO and 11 company holidays.

• Health Savings Account (HSA) and Flexible Spending Account (FSA).

• Coverage for long- and short-term disability.

• Annual wellness stipend for employees.

• 401(k) plan.

• Parental leave and family planning support benefits.

• Company-issued laptop.

• Annual stipend for remote work expenses.

• Commuter benefits (if applicable).

• Opportunities for career advancement.

• A collaborative culture driven by a mission to enhance patient care.