Payer Operations Specialist
Core
Subject matter expert and escalations contact for payer credentialing and operations, ensuring speed and accuracy of in-network access expansion.
Role type
Payer Operations Specialist (Healthcare Revenue Cycle)
Builds
In-network access for providers across the US
Domain
Healthcare / Payer Operations / Credentialing
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Provider enrollment, credentialing, payer contracting, SOP documentation, pipeline metrics reporting, payer portal navigation, proactive follow-up, error detection
Preferred skills
Availity portal experience, commercial payer requirements, multi-state telehealth environment, NCQA/CMS standards
Responsibilities
Document and maintain end-to-end SOPs for payer contracting and enrollment, implement quality controls to reduce rework, identify bottlenecks and drive cycle-time improvements, maintain enrollment trackers and escalate blockers, conduct persistent follow-up with payers to resolve deficiencies and push applications to approval, partner with RCM and strategy teams on payer initiatives
Seniority
Mid-level, hands-on IC