Note: The job is a remote job and is open to candidates in USA. Nadia Care is a maternity care company focused on improving pregnancy, birth, and postpartum support for underserved communities. The Credentialing & Payer Operations Manager will own provider licensing, payer enrollment, and credentialing operations, while building scalable workflows, maintaining compliance, and coordinating with providers, health plans, billing, and client success teams.
Responsibilities
- 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
- 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
- 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
- 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
- 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
- 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
Skills
- 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)
- 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
- 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
- Hands-on experience with Medallion (or similar credentialing tracking platforms) is strongly preferred
Benefits
- 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.
- 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.
- 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.
Company Overview