Credentialing & Payer Operations Manager

**About Us:** The United States has the poorest maternal and birth outcomes of all developed countries with the underserved, Black, Brown, Indigenous communities disproportionately affected. Nadia Care is working to drastically change the experience of affected communities by reimagining how we deliver meaningful and compassionate care to expectant moms. [Nadia Care’s](https://www.nadiacare.com/) mission is to improve pregnancy, birth and the postpartum journey for women and their families by reimagining how maternity care is delivered. Our team is focused on building trust-based engagement and wrap-around support for expectant moms at home, in person and virtually to ensure they have all the social support they need for a successful and joyful pregnancy journey. We help our members with care navigation, doula support, assistance with lactation, nutrition, housing, transportation and a wide range of other needs. We leverage technology to support our virtual engagement that allows us to meet all our moms where they are. We ensure that our members have trusted sources for support, resources, and information throughout their pregnancy, delivery and well into postpartum. Nadia Care does not replace the primary obstetrician or doctor’s relationships. Instead, we support expectant mothers with all other health-related social needs not typically available through their doctors’ offices. **Our Values:** - *Empathy**is at the heart of everything we do. We must always center the experiences of the mothers and families we serve, as well as support and uplift one another.* - *Collaboration**is what makes us stronger. We achieve the greatest impact when we work together, share knowledge, and elevate each other’s strengths.* - *Resilience**reflects our ability to push through challenges, adapt in a fast-changing environment, and remain committed to our mission no matter the obstacles.* **The Role:** The **Credentialing & Payer Operations Manager** will own end-to-end provider licensing, payer enrollment, and credentialing operations. This hands-on role requires someone who thrives "in the weeds" building scalable internal processes, maintaining strict regulatory compliance, and driving fast time-to-credentialing metrics. Initially operating as a team of one, this role will establish foundational workflows for our Care Team (including Doulas) while serving as the primary bridge between providers, health plans, billing, and client success teams. **Key Responsibilities** **Provider Onboarding, Licensing & Doula Readiness** - Manage full lifecycle licensing, credentialing, and re-credentialing applications for all Care Team members across multiple states. - Build and execute Doula Readiness workflows to onboard non-traditional care providers efficiently into payer networks. - Collect, audit, and verify primary source documentation required for payor and state credentialing packages. - Directly communicate with providers to gather missing documentation, guide them through state renewal procedures, and clear onboarding bottlenecks. **Licensure Maintenance, Certifications & CEU Tracking** - Proactively monitor and track all clinical and non-clinical staff credentials, state license expiration dates, BLS/CPR certifications, and mandatory Continuing Education Units (CEUs). - Build structured automated workflow reminders in Medallion to advise care team members on upcoming renewal deadlines and mandatory continuing education requirements. - Audit and record completion certificates for required clinical trainings, state-mandated CEUs, and specialty accreditations prior to credential expiration. **Process Operations, Systems & Performance** - Establish, standardize, and optimize internal credentialing and payer enrollment processes from scratch. - Own and maintain the credentialing management platform (Medallion) for automated tracking, expiration alerts, and primary source verification reporting. - Track and optimize key operational KPIs, specifically driving down Time-to-Credentialing to accelerate provider deployment and revenue generation. - Generate regular performance analytics and status reports for leadership regarding provider readiness and enrollment pipelines. **Revenue Cycle Management (RCM) & Payer Relations** - Oversee the credentialing-to-claims bridge, ensuring providers are properly linked to billing systems prior to service delivery to prevent claim denials. - Submit credentialing packages directly to commercial insurance plans, Medicaid entities, and managed care organizations. - Partner closely with Revenue Cycle Management (RCM), billing, and coding teams to troubleshoot credentialing-related claims issues or enrollment delays. **Regulatory Compliance & Risk Management** - Monitor state licensure bodies, OIG exclusions, Medicaid/Medicare sanction reports, and the National Practitioner Data Bank (NPDB) to ensure clean provider rosters. - Stay up to date on evolving healthcare regulations, state licensing requirements, HIPAA guidelines, and payer-specific enrollment rules. - Manage client-facing compliance reporting, delivering accurate documentation to meet health plan and enterprise client audit standards. **Client Communication & Stakeholder Alignment** - Serve as the functional point of contact for enterprise clients regarding provider panel status and credentialing timelines. - Collaborate internally with Implementation and Client Success teams to align provider availability with client go-live targets. **Qualifications** - 5+ years of healthcare credentialing, provider operations, and payer enrollment experience. - Proven experience submitting initial state licensure applications across multiple states simultaneously and tracking recurring certification/CEU requirements. - Bachelor’s degree in Healthcare Administration, Business, or related field (Associates degree accepted with equivalent hands-on experience). - Hands-on experience with Medallion (or similar credentialing tracking platforms) is strongly preferred. **Key Skill Sets** - Strong project management skills to track dozens of active licenses, BLS certifications, CEU deadlines, and payer files simultaneously. - Comfortable operating independently, solving complex payer delays, and building processes without a pre-existing playbook. - Excellent verbal and written skills for interfacing with providers, health plan representatives, internal billing teams, and enterprise clients. - Practical understanding of how credentialing linkages directly impact billing cycles and claims reimbursement. Compensation range for this position is between $80K-$90K. The exact amount will depend on direct, relevant experience. **Our Interview Process** At Nadia Care, we value transparency and want you to feel prepared at every stage of your candidate journey. Below is our standard interview process for this role*:* 1. **Recruiter Interview** | 30 minutes 2. **Hiring Manager Interview** | 1 hour 3. **Team Interview** | 1 hour 4. **Executive Leadership Interview** | 45 minutes *Please note that this process is subject to change, but we will always keep you informed along the way.* For full-time employees, we offer a comprehensive benefits package designed to support you both professionally and personally: **Time Off That Works for You** - Recharge with annual paid holidays off. - Full-Time Salaried Employees (Exempt): Enjoy unlimited time off after the 90-day introductory period. - Full-Time Hourly Employees (Non-Exempt): Receive three weeks of paid time off after the 90-day introductory period. **Comprehensive Health & Wellness Coverage** - Medical Insurance: Access top-tier healthcare, covering hospital, surgical, and prescription drug benefits. Coverage begins the first of the following month. - Dental Insurance: Coverage for preventive care, as well as basic and major procedures. - Vision Insurance: Coverage for routine eye exams and eyeglasses. **Security & Future Planning Options** - Stock Option Grant: We believe in shared success. - Life Insurance: Financial protection for your beneficiaries. - Disability Insurance: Short-term and long-term coverage in case of illness or injury. - 401(k) Retirement Plan: Opportunity to save for the future. We’re building something great and want you to be part of it. If you're looking for a fast-paced, dynamic environment where your contributions make an impact, apply today! *Remote positions are open to candidates in the **contiguous US only.** Due to operational and compliance requirements, we are unable to hire candidates residing in ND, AL, HI, PR or outside the contiguous US.* *Please note that our recruitment team will only contact candidates via an official company email address ending in @[](http://cayabacare.com/). Be cautious of scams; Nadia Care will never ask for financial information or payments at any stage of the hiring process.*