Payer Operations Specialist

The Opportunity

We're seeking an enthusiastic and process-driven Payer Operations Specialist to serve as a subject matter expert and payer escalations contact on the credentialing and payer operations team. As we expand in-network access across the country, this role directly owns the speed and accuracy of payer expansion — the difference between providers who can see members on day one and applications that stall. You will be responsible for investigating stalled applications, new payer processes, and reviewing quality across the team to ensure consistency and SLA execution.

Your Impact

• Assist Payer Operations leadership with documenting and maintaining end-to-end SOPs for payer contracting, enrollment, and credentialing workflows — turning tribal knowledge into repeatable, auditable processes

• Implement quality controls and error-catching checkpoints that reduce rework and rejected applications

• Identify bottlenecks in the expansion pipeline and drive cycle-time improvements

• Keep enrollment and contracting trackers meticulously up to date, flag aging items and delays, and escalate blockers with proposed solutions

• Conduct persistent, proactive follow-up with payers via phone, email, and payer portals to confirm application receipt, resolve deficiencies, and push applications through to approval. You own each item until it's done

• Partner with RCM and payer strategy/business development teams in collaborative problem-solving or strategic payer initiatives.

• Assist with application submission, as needed.

Required Qualifications

• 2+ years of experience in provider enrollment, credentialing, payer contracting, or healthcare administration (internship or adjacent revenue cycle experience considered)

• Demonstrated experience building or documenting processes and SOPs

• Comfort owning metrics and reporting on pipeline throughput

• Highly independent and driven. You follow up relentlessly (including comfort calling and escalating within payer networks), manage your own queue without reminders, and don't let applications sit

• Exceptional attention to detail and organizational skills; you take pride in accurate, deadline-driven work

Preferred Qualifications

• Hands-on experience with payer portals and third party portals i.e. Availity

• Familiarity with commercial payer requirements (Understanding Medicare and Medicaid processes is a plus)

• Experience in multi-state telehealth, digital health, or a high-growth healthcare environment

• Exposure to credentialing standards (e.g., NCQA, CMS)