Credentialing & Payer Operations Manager
Core
Own end-to-end provider licensing, payer enrollment, and credentialing operations for a maternity care team including doulas.
Role type
Healthcare credentialing and payer operations manager
Builds
Scalable internal credentialing workflows and payer network enrollment for non-traditional care providers
Domain
Healthcare administration / Maternity care / Payer relations
Deliverable
Production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Healthcare credentialing, provider operations, payer enrollment, multi-state licensure management, CEU tracking, Medallion platform, regulatory compliance, project management, claims reimbursement linkage
Preferred skills
Medallion platform experience, building processes from scratch
Technologies
Medallion
Responsibilities
Manage full lifecycle licensing and re-credentialing for Care Team members; Build Doula Readiness workflows; Track license expiration dates and mandatory CEUs; Establish and optimize internal credentialing processes; Submit credentialing packages to commercial insurance and Medicaid; Monitor OIG exclusions and NPDB; Serve as point of contact for enterprise clients regarding provider panel status
Seniority
Mid-level, hands-on IC