Manager, Credentialing & Payer Operations

Allara•Houston, TX

8d•$90,000 - $100,000•Hybrid

About The Position

Allara is expanding its footprint and volume rapidly, and Payer Operations is the engine that keeps us growing, handling enrollment, credentialing, and the payer-side processes that allow clinicians to see patients. The Manager of Credentialing and Payer Operations runs this engine day to day, owning the throughput, quality, and reliability of payer operations as volume scales, and building a team that can absorb this growth without a proportional increase in headcount or manual work.

Requirements

5+ years of experience in high growth operations, with a preference for direct exposure to provider credentialing, licensing and payer enrollment
Demonstrated ability to build and improve operational systems in a fast-moving, resource-constrained environment
Process-obsessed and detail-oriented: you see inefficiency and can't help but fix it
Strong analytical skills: comfortable pulling data, identifying trends, and translating insights into operational decisions
Excellent cross-functional communicator, able to work across teams and move things forward without direct authority
Genuinely excited by automation, tooling, and AI. You see technology as a force multiplier, not a threat

Nice To Haves

Experience in telehealth or multi-state provider network operations
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)

Responsibilities

Build and strengthen structures to ensure providers are credentialed in a timely and compliant manner; work to automate and optimize this process and ensure a fast and high quality provider experience
Administer our Credentialing Committee, collaborating with clinical leadership to enforce guidelines, provide timely review of files, and coordinate provider applications
Own relationships with our credentialing/CVO vendors to monitor and improve SLA performance
Own day-to-day provider data maintenance and the architecture to support all credentialing and licensing needs at scale
Serve as the subject matter expert with provider enrollments with health plans; developing relationships with key contacts and documenting/embedding the enrollment processes/SOPs within the team workflows
Design quality controls and error-catching checkpoints that reduce rework and rejected applications
Ensure the team documents updates meticulously
Actively monitor team performance and SLAs, flagging aging items and escalations quickly to identify and solve root cause issues before they become systematic problems
Coach and lead a team of US based and international specialists
Coordinate cross-functionally with RCM, payer strategy/ business development teams to investigate and solve root cause problems in our payer and claims cycles and in our national expansion efforts
Train new team members to be successful and productive members of the team quickly
Set and enforce performance standards across the team
Work with product, engineering and other teams to design automations and AI based flows that make the team more efficient in delivering consistent quality work