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Credentialing & Payer Operations Manager

2 weeks, 6 days ago
United States
Full-time
Senior
Operations Manager
Operations
HIPAA
Apply Now
Nadia Care

Nadia Care

Nadia Care provides comprehensive pregnancy and postpartum care through a combination of in-home services and virtual support, ensuring mothers receive the necessary assistance and guidance throughout their journey to healthier pregnancies and deliveries.

Health Care Providers & Services
Founded 2021
View All Jobs 5

Description

  • Manage licensing, credentialing, and re-credentialing applications for Care Team members across multiple states.
  • Build onboarding and Doula Readiness workflows for non-traditional providers entering payer networks.
  • Collect, audit, and verify primary-source documentation and resolve provider onboarding bottlenecks.
  • Track licenses, certifications, CEUs, renewals, and required training through Medallion or similar systems.
  • Establish and optimize credentialing and payer enrollment processes, workflows, and performance metrics.
  • Submit credentialing packages to commercial insurers, Medicaid entities, and managed care organizations.
  • Ensure provider credentialing linkages are complete before services begin to prevent billing and claims issues.
  • Monitor licensing bodies, exclusion lists, sanctions, NPDB records, HIPAA requirements, and payer rules.
  • Produce provider readiness, enrollment pipeline, compliance, and performance reports for leadership and clients.
  • Coordinate with providers, health plans, RCM, billing, coding, Implementation, Client Success, and enterprise clients.

Requirements

  • 5+ years of experience in healthcare credentialing, provider operations, and payer enrollment.
  • Experience submitting multi-state licensure applications and tracking recurring certifications and CEU requirements.
  • Bachelor’s degree in Healthcare Administration, Business, or a related field; an associate degree with equivalent experience is accepted.
  • Hands-on experience with Medallion or a similar credentialing platform is strongly preferred.
  • Strong project management skills for managing multiple licenses, certifications, CEUs, and payer files simultaneously.
  • Ability to work independently, resolve complex payer delays, and build processes without an existing playbook.
  • Excellent written and verbal communication skills for working with providers, payers, billing teams, and clients.
  • Understanding of how credentialing linkages affect billing cycles, claims, and reimbursement.
  • Remote candidates must reside in the contiguous United States; hiring is unavailable in ND, AL, HI, and PR.

Benefits

  • $80,000–$90,000 annual compensation, depending on relevant experience.
  • Unlimited PTO for exempt full-time employees or three weeks of paid time off for non-exempt full-time employees after 90 days.
  • Annual paid holidays.
  • Medical, dental, and vision insurance.
  • Stock option grant.
  • Life, short-term disability, and long-term disability insurance.
  • 401(k) retirement plan.

Interested in this position?

Apply directly on the company website

Apply Now

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