Manager, Payer Enrollment - Remote

Overview

As Payer Enrollment Manager, you’ll be a key leader in our credentialing and compliance operations, overseeing both delegated and non-delegated credentialing processes, managing payer enrollment workflows, and ensuring compliance with accreditation and contractual requirements.

In Short

• Oversee and audit the performance of Credentialing Verification Organizations (CVOs).
• Lead audits and ongoing monitoring for delegated contracts.
• Manage payer credentialing and enrollment functions.
• Ensure compliance with NCQA, CMS, state, and commercial payer requirements.
• Optimize workflows for application submission and recredentialing.
• Serve as the primary contact for credentialing escalations.
• Collaborate with Compliance, Product, and Revenue Cycle Management teams.
• Track and analyze performance metrics related to credentialing.
• Support the development of internal policies and procedures.
• Maintain detailed records for internal reporting and compliance.

Requirements

• 5+ years of experience in healthcare credentialing or payer enrollment.
• Knowledge of NCQA standards, CAQH, and Medicare/Medicaid enrollment.
• Experience managing CVOs and auditing credentialing processes.
• Ability to develop and optimize credentialing workflows.
• Strong communication and stakeholder management skills.
• Analytical mindset with experience in data tracking.
• Ability to balance multiple priorities in fast-paced environments.

Benefits

• Health, Dental, Vision benefits starting on the first day.
• Employer sponsored 401(k) match up to 2%.
• Yearly allotment of no-cost visits to mental health providers.
• Competitive paid time off policies.
• Parental leave of 18 weeks for birthing parents.
• Access to fertility care support and reimbursement.
• Professional Development Reimbursement up to $1,000 a year.
• $200 per year donation matching.
• Access to fitness and wellness programs.
• Childcare and elder care support through partnerships.