Payer Operations Lead
Core
Own complex payer enrollments, build documented processes, and coach the enrollment team to expand in-network access for a women's health platform.
Role type
Payer Operations Lead
Builds
Payer contracting, enrollment, and credentialing workflows for a US-based women's health platform
Domain
Healthcare administration / Payer contracting
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Payer enrollment and credentialing, SOP documentation, process improvement, quality control, pipeline tracking, proactive follow-up, contract application management, team coaching
Preferred skills
Availity portal usage, Medicare/Medicaid processes, multi-state telehealth, NCQA/CMS standards
Technologies
Availity, payer portals
Responsibilities
Build and maintain SOPs for payer contracting and enrollment; Design quality controls to reduce rework; Identify bottlenecks and drive cycle-time improvements; Track applications and escalate blockers; Conduct persistent follow-up with payers to resolve deficiencies; Coach offshore team members on standards and playbooks; Partner with RCM and strategy teams on payer initiatives
Seniority
Mid-level, hands-on IC