Manager, Credentialing & Payer Operations
Core
Manage the end-to-end credentialing and payer enrollment engine to ensure timely, compliant provider onboarding and claims processing for a rapidly scaling women's health platform.
Role type
Manager of Credentialing and Payer Operations
Builds
Provider credentialing workflows, payer enrollment processes, and operational systems for a national women's health network.
Domain
Healthcare operations, payer relations, credentialing, and telehealth.
Required skills
operational system design, process optimization, data analysis, cross-functional communication, vendor management, team leadership, automation strategy
Preferred skills
telehealth network operations, payer portal expertise (e.g., Availity), commercial payer requirements, multi-state operations, NCQA/CMS standards
Technologies
payer portals, third-party credentialing vendors, automation tools, AI-based workflows
Responsibilities
Build structures for timely and compliant provider credentialing; administer the Credentialing Committee; manage vendor relationships and SLAs; design quality controls for payer enrollments; coach and lead a team of specialists; coordinate cross-functionally with RCM and business development teams.
Seniority
Manager, hands-on leadership