Credentialing & Payer Operations Manager
New
J
JobgetherHealthcare
Remote eligibility is limited to candidates residing in the contiguous United States; candidates residing in North Dakota, Alabama, Hawaii, Puerto Rico, or outside the contiguous U.S. are not eligible.Full-TimeManager
Salary$80,000–$90,000 USD
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Job Details
- Experience
- 5+ years
- Required Skills
- Project ManagementHIPAA
Requirements
- 5+ years of experience in healthcare credentialing, provider operations, payer enrollment, or a closely related healthcare operations function.
- Demonstrated experience managing initial state licensure applications across multiple states simultaneously.
- Bachelor’s degree in Healthcare Administration, Business, or a related discipline.
- Hands-on experience with Medallion or a similar credentialing and provider management platform.
- Direct experience with doula credentialing, Medicaid doula registries, or onboarding non-traditional care providers.
- Strong understanding of the interconnection between provider credentialing, payer enrollment, billing, and claims processing.
- Proven ability to create automated tracking and reminder workflows for licensing, certifications, and renewals.
- Strong project management skills with the ability to manage numerous files and records simultaneously.
- High attention to detail and commitment to regulatory accuracy and documentation quality.
Responsibilities
- Manage the full lifecycle of provider licensing, credentialing, and re-credentialing for care team members across multiple states.
- Build and execute efficient onboarding and readiness workflows for doulas and other non-traditional care providers entering payer networks.
- Collect, audit, verify, and maintain primary-source documentation required for state licensing and payer credentialing applications.
- Establish automated reminders and tracking workflows within credentialing systems to ensure renewals and required training are completed on time.
- Track operational KPIs, particularly Time-to-Credentialing, and use performance data to identify bottlenecks and improve provider deployment timelines.
- Submit credentialing and enrollment packages to commercial insurers, Medicaid entities, and managed care organizations.
- Partner with revenue cycle management, billing, and coding teams to resolve credentialing-related claims issues, enrollment delays, and reimbursement risks.
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