Payer Operations Specialist

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

📋 Description

• Act as a subject matter expert and the primary contact for payer escalations within the credentialing and payer operations team.

• Create and uphold comprehensive SOPs for payer contracting, enrollment, and credentialing workflows.

• Establish quality control measures and error-detection checkpoints to minimize rework and avoid rejected applications.

• Detect bottlenecks in the expansion pipeline and initiate improvements in cycle times.

• Oversee enrollment and contracting trackers, highlight aging items and delays, and escalate issues with recommended solutions.

• Communicate with payers through phone, email, and payer portals to verify application receipt, address deficiencies, and expedite application approvals.

• Take ownership of each application item until completion.

• Collaborate with RCM and payer strategy/business development teams on joint problem-solving and strategic payer initiatives.

• Provide assistance with application submissions when necessary.

⛳️ Requirements

• A minimum of 2 years of experience in provider enrollment, credentialing, payer contracting, or healthcare administration (internship or relevant revenue cycle experience is acceptable).

• Proven experience in developing or documenting processes and SOPs.

• Comfortable managing metrics and reporting on pipeline throughput.

• Highly self-motivated and driven.

• Comfortable making calls and escalating issues within payer networks.

• Ability to manage personal workload independently without prompts.

• Exceptional attention to detail and strong organizational skills.

• Familiarity with payer portals and third-party platforms like Availity (preferred).

• Knowledge of commercial payer requirements; understanding Medicare and Medicaid processes is advantageous (preferred).

• Experience in multi-state telehealth, digital health, or a rapidly growing healthcare environment (preferred).

• Familiarity with credentialing standards such as NCQA and CMS (preferred).

🏝️ Benefits

• Equity.

• Professional development & employee learning programs.

• Comprehensive health benefits (medical, dental, vision).

• Generous paid time off.

• Additional wellness and professional development perks.

• 100% remote work opportunity within the U.S.

• Unlimited PTO & 11 company holidays.

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

• Long- and short-term disability coverage.

• Annual employee wellness stipend.

• 401(k) plan.

• Parental leave & family planning support benefits.

• Company-issued laptop.

• Annual work-from-home stipend.

• Commuter benefits (if applicable).

• A collaborative, mission-driven culture dedicated to enhancing patient care.