Credentialing & Enrollment Lead
About The Position
We are seeking a Credentialing & Enrollment Lead to own our multi-state provider enrollment strategy end-to-end. This is a strategic role where you will shape our approach to payer relationships, contracting, and multi-state enrollment. You will work directly with the founders and report to the COO. This position has a direct impact on our payer strategy, enrollment operations, and ability to scale to new states. You will collaborate closely with leadership and our clinical team to build the credentialing infrastructure necessary to serve patients. This is a full-time role, with openness to part-time or contract arrangements for the right candidate.
Requirements
- Experience with multi-state telehealth credentialing, beyond in-person, single-location enrollment.
- Understanding of PC-MSO structures and their impact on payer enrollment.
- Direct experience working with Medicare Advantage payers and state Medicaid programs.
- Proficiency with CAQH, PECOS, and at least a few state Medicaid portals.
- Experience with payer contracting, understanding post-credentialing processes.
- Ability to operate independently and bring solutions.
- Comfort working in a small, fast-moving team with significant ownership and direct access to leadership.
Nice To Haves
- Experience with delegated credentialing.
- Experience with MAC jurisdictions.
- Experience with EDI enrollment.
Responsibilities
- Own provider enrollment end-to-end, including MA, Medicaid, and Original Medicare across multiple states, managing applications, follow-ups, and issue resolution.
- Lead credentialing strategy, utilizing knowledge of CAQH, PECOS, and state Medicaid portals to determine necessary actions and order.
- Navigate payer contracting, understanding fee schedules, contracting timelines, and negotiable aspects.
- Build the enrollment playbook by documenting processes to ensure knowledge is not siloed.
- Troubleshoot and escalate issues when applications stall, are denied, or are filed incorrectly.
- Advise on structure, understanding the interaction of PC-MSO structures, telehealth, and multi-state licensure with enrollment.
Benefits
- Mission with meaning
- High ownership
- Real impact
- Opportunity to grow with the company and build the credentialing function
- Meaningful early equity
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
