Credentialing & Payer Operations Manager

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $80k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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Nadia Care

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2021

🏥 Healthcare

👥 B2C

Healthcare • B2C

Nadia Care is a membership-based maternal support service that provides community-centered, in-person and online care for people during pregnancy and after childbirth. They provide expert maternity coaching, coordinate a team to support feeding, nutrition, labor, and recovery, and connect members to local resources (housing, rides, other supports). Nadia Care works alongside a member's clinical providers to fill gaps in support and scale maternal care services through partnerships (noted as an ACAP Preferred Vendor).

📋 Description

• Manage full lifecycle licensing, credentialing, and re-credentialing applications for Care Team members across multiple states • Build and execute Doula Readiness workflows for onboarding non-traditional care providers into payer networks • Collect, audit, and verify primary source documentation for payer and state credentialing packages • Communicate with providers to gather missing documentation, guide state renewal procedures, and clear onboarding bottlenecks • Monitor clinical and non-clinical staff credentials, state license expirations, BLS/CPR certifications, and CEUs • Build automated workflow reminders in Medallion for renewal deadlines and continuing education requirements • Audit and record completion certificates for trainings, CEUs, and specialty accreditations • Establish, standardize, and optimize credentialing and payer enrollment processes • Own and maintain the Medallion credentialing management platform • Track and optimize operational KPIs, including Time-to-Credentialing • Generate performance analytics and status reports for leadership • Oversee the credentialing-to-claims bridge and provider-billing system linkages • Submit credentialing packages to commercial insurance plans, Medicaid entities, and managed care organizations • Partner with RCM, billing, and coding teams on credentialing-related claims issues and enrollment delays • Monitor licensure bodies, OIG exclusions, Medicaid/Medicare sanctions, and NPDB records • Maintain compliance with healthcare regulations, state licensing requirements, HIPAA guidelines, and payer enrollment rules • Manage client-facing compliance reporting for health plan and enterprise client audits • Serve as functional contact for enterprise clients regarding provider panel status and credentialing timelines • Collaborate with Implementation and Client Success teams to align provider availability with client go-live targets

🎯 Requirements

• 5+ years of healthcare credentialing, provider operations, and payer enrollment experience • Experience submitting initial state licensure applications across multiple states simultaneously • Experience tracking recurring certification and CEU requirements • Bachelor’s degree in Healthcare Administration, Business, or related field; Associates degree accepted with equivalent hands-on experience • Hands-on experience with Medallion or similar credentialing tracking platforms is strongly preferred • Strong project management skills • Ability to track multiple active licenses, BLS certifications, CEU deadlines, and payer files simultaneously • Ability to operate independently, solve complex payer delays, and build processes without a pre-existing playbook • Excellent verbal and written skills • Practical understanding of credentialing linkages, billing cycles, and claims reimbursement

🏖️ Benefits

• Annual paid holidays • Unlimited time off for full-time salaried employees after the 90-day introductory period • Three weeks of paid time off for full-time hourly employees after the 90-day introductory period • Medical insurance covering hospital, surgical, and prescription drug benefits • Dental insurance • Vision insurance • Stock option grant • Life insurance • Short-term and long-term disability insurance • 401(k) retirement plan