Credentialing & Payer Operations Manager
N
Nadia CareHealthcare
Remote positions are open to candidates in the contiguous US only. Due to operational and compliance requirements, we are unable to hire candidates residing in ND, AL, HI, PR or outside the contiguous US.Full-TimeManager
Salary$80K-$90K
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Job Details
- Experience
- 5+ years
- Required Skills
- Project ManagementHIPAA
Requirements
- 5+ years of healthcare credentialing, provider operations, and payer enrollment experience.
- Proven experience submitting initial state licensure applications across multiple states simultaneously.
- Experience tracking recurring certification and CEU requirements.
- Bachelor’s degree in Healthcare Administration, Business, or related field (Associates degree accepted with equivalent hands-on experience).
- Hands-on experience with Medallion or similar credentialing tracking platforms.
- Strong project management skills to handle multiple active licenses, certifications, and payer files.
- Ability to operate independently and build processes without a pre-existing playbook.
- Practical understanding of how credentialing linkages impact billing cycles and claims reimbursement.
- Excellent verbal and written skills for interfacing with providers, health plans, and billing teams.
Responsibilities
- Manage full lifecycle licensing, credentialing, and re-credentialing applications for all Care Team members across multiple states.
- Build and execute Doula Readiness workflows to onboard non-traditional care providers efficiently into payer networks.
- Monitor and track clinical and non-clinical staff credentials, state license expiration dates, and mandatory Continuing Education Units (CEUs).
- Establish, standardize, and optimize internal credentialing and payer enrollment processes from scratch.
- Oversee the credentialing-to-claims bridge and collaborate with RCM and billing teams to prevent claim denials.
- Ensure regulatory compliance by monitoring licensure bodies, OIG exclusions, and NPDB reports.
- Serve as the functional point of contact for enterprise clients regarding provider panel status.
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