Payer Operations Lead
New
100% remote within the U.S.Full-TimeLead
Salary$60,000-$68,000
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Job Details
- Experience
- 2-3 years of experience
- Required Skills
- Process improvement
Requirements
- 2-3 years of experience in provider enrollment, credentialing, payer contracting, or healthcare administration.
- Demonstrated experience building or documenting processes and SOPs.
- Experience coaching, training, or quality-reviewing others' work.
- Comfort owning metrics and reporting on pipeline throughput.
- Highly independent with strong follow-up skills, including experience calling and escalating within payer networks.
- Exceptional attention to detail and organizational skills.
- Ability to manage an individual queue without external reminders.
- Hands-on experience with payer portals and third-party portals like Availity preferred.
- Familiarity with commercial payer requirements (Medicare/Medicaid experience is a plus).
- Experience in multi-state telehealth, digital health, or high-growth healthcare environments preferred.
- Exposure to credentialing standards such as NCQA or CMS preferred.
Responsibilities
- Build, document, and maintain end-to-end SOPs for payer contracting, enrollment, and credentialing workflows.
- Design quality controls and error-catching checkpoints to reduce application rejections.
- Identify and resolve bottlenecks in the expansion pipeline to improve cycle times.
- Conduct persistent follow-up with payers to confirm receipt, resolve deficiencies, and push applications to approval.
- Prepare, submit, and track payer contract applications for new partnerships and service lines.
- Serve as a quality and productivity coach for the offshore enrollment team.
- Assist in onboarding and ramping offshore contributors on payer processes.
- Partner with RCM and business development teams on strategic payer initiatives.
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