Credentialing & Payer Operations Manager

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Credentialing & Payer Operations Manager based in United States.

As a Credentialing & Payer Operations Manager, you will own the systems and processes that enable care providers to become credentialed, licensed, and ready to serve members.

You will manage end-to-end provider credentialing, payer enrollment, licensing, and re-credentialing activities across multiple states.

This is a hands-on opportunity to build scalable operations from the ground up in a fast-moving healthcare environment.

You will work closely with providers, health plans, billing and revenue cycle teams, implementation teams, and enterprise clients.

A major focus will be improving time-to-credentialing while maintaining accurate documentation and strict regulatory compliance.

You will also develop automated workflows, reporting, and operational standards that improve provider readiness and support revenue generation.

This role is ideal for an organized, independent operator who enjoys solving complex payer challenges and building processes that make a measurable difference.

Accountabilities

• 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.
• Communicate directly with providers to obtain missing documentation, guide renewal activities, and resolve onboarding bottlenecks.
• Monitor clinical and non-clinical credentials, state license expirations, BLS/CPR certifications, continuing education requirements, and specialty accreditations.
• Establish automated reminders and tracking workflows within credentialing systems to ensure renewals and required training are completed on time.
• Build, standardize, and continuously improve credentialing and payer enrollment processes, workflows, and operating procedures.
• Own the credentialing management platform, maintaining accurate records, expiration alerts, verification information, and reporting.
• Track operational KPIs, particularly Time-to-Credentialing, and use performance data to identify bottlenecks and improve provider deployment timelines.
• Prepare regular analytics and status reports for leadership covering provider readiness, credentialing activity, and payer enrollment pipelines.
• Oversee the credentialing-to-claims process, ensuring providers are correctly connected to billing systems before services are delivered.
• 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.
• Monitor state licensing authorities, OIG exclusion databases, Medicaid and Medicare sanction reports, and the National Practitioner Data Bank to maintain compliant provider rosters.
• Stay current with healthcare regulations, state licensing requirements, HIPAA guidelines, and payer-specific enrollment requirements.
• Provide accurate compliance documentation and reporting for health plans and enterprise client audits.
• Serve as the primary operational contact for clients regarding provider panel status, credentialing progress, and expected timelines.
• Collaborate with implementation and client success teams to align provider availability and credentialing progress with client go-live requirements.

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 and tracking recurring certifications, CEUs, and renewal requirements.
• Bachelor’s degree in Healthcare Administration, Business, or a related discipline; an associate degree may be accepted with equivalent hands-on experience.
• Hands-on experience with Medallion or a similar credentialing and provider management platform is strongly preferred.
• Direct experience with doula credentialing, Medicaid doula registries, or onboarding non-traditional care providers into managed care networks is highly valuable.
• Strong understanding of how provider credentialing, payer enrollment, billing systems, claims processing, and reimbursement are interconnected.
• Strong project management and organizational skills, with the ability to manage numerous licenses, certifications, payer files, deadlines, and provider records simultaneously.
• Experience creating automated tracking and reminder workflows for multi-state licensing, CPR/BLS certifications, CEUs, and other provider requirements.
• Ability to work independently, take ownership of ambiguous problems, and establish processes without an existing playbook.
• Strong analytical and problem-solving skills, particularly when addressing payer delays, credentialing bottlenecks, and compliance issues.
• Excellent written and verbal communication skills, with the ability to work effectively with providers, health plans, billing teams, internal stakeholders, and enterprise clients.
• High attention to detail and a strong commitment to regulatory accuracy, documentation quality, and confidentiality.
• Adaptability, resilience, and a collaborative mindset suited to a fast-paced, mission-driven healthcare environment.
• Must be eligible to work in the United States without immigration sponsorship.
• 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.

Benefits

• Compensation range of $80,000-$90,000 USD, depending on directly relevant experience.
• Comprehensive medical insurance, including hospital, surgical, and prescription drug coverage.
• Dental insurance covering preventive, basic, and major services.
• Vision insurance for routine eye care and eyewear.
• Unlimited paid time off for eligible full-time salaried employees after the 90-day introductory period.
• Paid holidays.
• Stock option grant, providing an opportunity to participate in shared company success.
• Life insurance coverage.
• Short-term and long-term disability insurance.
• 401(k) retirement savings plan.
• Fully remote work opportunity within eligible U.S. locations.
• Opportunities for professional growth and career development.
• Supportive, collaborative, and mission-driven working environment.
• Opportunity to build foundational credentialing and payer operations processes with meaningful impact on healthcare delivery.