Credentialing and Payer Enrollment Manager

Yesterday

Apply Now

Receive Emails with Similar Jobs

Affect Therapeutics

WebsiteLinkedInAll Job Openings

Healthcare Insurance • Wellness • SaaS

Affect Therapeutics is a company that provides a smartphone app designed for the treatment of drug and alcohol addiction. Their integrated digital treatment program offers a variety of features such as secure video conference appointments, progress tracking, and access to a care team. The app utilizes contingency management by offering financial incentives to encourage healthy habits. The program combines individual and group therapy, along with medication management to improve recovery outcomes. Affect Therapeutics aims to support individuals not only in achieving sobriety but also in enhancing their overall life quality. The company emphasizes privacy, technology, and continuous support throughout the recovery journey.

11 - 50 employees

⚕️ Healthcare Insurance

🧘 Wellness

☁️ SaaS

💰 $6M Seed Round on 2021-08

📋 Description

• Own and continuously improve the end-to-end credentialing and enrollment lifecycle for all providers across our operations • Build scalable processes and documentation that support rapid company growth, new state/programmatic expansions, and evolving payer requirements • Implement a systems-thinking approach to credentialing, ensuring workflows integrate cleanly with RCM, compliance, recruitment, finance, and clinical operations • Evaluate and deploy new tools, data workflows, and automation opportunities to increase speed, accuracy, and visibility across credentialing processes • Monitor KPIs, cycle times, and bottlenecks; develop and execute improvement plans • Oversee all payer enrollment activities (Medicaid, Employer, Marketplace, and Medicare plans), ensuring timely and accurate submission, follow-through, and completion • Maintain continuous compliance with payer, state, and federal standards—including revalidations, expirables, and recredentialing cycles • Serve as the internal expert on credentialing requirements, payer nuances, and market-specific rules • Maintain meticulous provider records, audit-ready documentation, and updated data across credentialing platforms and internal systems • Lead a growing credentialing and payer enrollment team, ensuring accountability, quality, and operational discipline across 20+ states and growing • Manage external credentialing vendors, including performance oversight, SLAs, and integration with internal workflows • Troubleshoot issues, set priorities, and guide the team through high-volume or fast-changing periods • Develop strategic relationships with payer representatives to accelerate enrollment cycles and resolve issues • Serve as Affect’s main representative to payers regarding credentialing questions, escalations, and operational nuances • Deliver clear, proactive communication to internal stakeholders about provider status, risks, and projected go-live timelines • Produce regular executive-level reporting on credentialing timelines, enrollment progress, risk areas, and performance metrics • Maintain dashboards or tracking systems that give leadership real-time visibility into enrollment status and throughput • Partner closely with RCM, Finance, and Operations to troubleshoot enrollment/credentialing barriers impacting claims or reimbursement.

🎯 Requirements

• 5+ years of experience in healthcare credentialing or payer enrollment, ideally in a multi-state environment • Proven success designing or managing scalable, systematized credentialing workflows • Experience with credentialing software and data systems; ability to learn and implement new tools; familiarity with Verifiable is a plus • Deep understanding of Medicaid and commercial payer credentialing requirements • Strong organizational ability, operational rigor, and comfort managing many moving pieces simultaneously • Exceptional communication and relationship-building skills—with both internal teams and stakeholders • Ability to thrive in a fast-paced, rapidly changing environment, maintaining accuracy and composure under pressure • Behavioral health familiarity is a plus, but not required.

🏖️ Benefits

• Health insurance • Remote work options