Role overview
The Payer Operations Specialist supports provider enrollment, credentialing, and payer expansion by resolving stalled applications, documenting processes, and improving execution against service-level agreements. This role serves as a subject matter expert and payer escalation contact, helping providers become ready to see members while maintaining accurate, consistent workflows.
Payer Workflows and Application Ownership
- Help Payer Operations leadership document and maintain end-to-end standard operating procedures for contracting, enrollment, and credentialing, converting informal knowledge into repeatable, auditable processes.
- Introduce quality controls and error checks that reduce rework and rejected applications.
- Identify expansion-pipeline bottlenecks and improve cycle times.
- Maintain enrollment and contracting trackers, flag aging items and delays, and escalate obstacles with proposed solutions.
- Follow up persistently with payers by phone, email, and payer portals to confirm receipt, correct deficiencies, and move each application through approval.
- Collaborate with revenue cycle management and payer strategy/business development teams on problem-solving and strategic initiatives.
- Support application submissions when needed and investigate new payer processes.
Required Qualifications
- Four or more years of provider enrollment and credentialing experience.
- Demonstrated experience building or documenting processes and standard operating procedures.
- Comfort owning metrics and reporting pipeline throughput.
- Independent queue management, persistent follow-through, and willingness to call and escalate within payer networks without reminders.
- Excellent attention to detail and organization, with accurate work delivered to deadlines.
Preferred Background
- Hands-on use of payer and third-party portals, such as Availity.
- Familiarity with commercial payer requirements; knowledge of Medicare and Medicaid processes is an additional plus.
- Experience in multistate telehealth, digital health, or a growing healthcare organization.
- Exposure to credentialing standards, including NCQA and CMS.
Location, Pay, and Development
This is a full-time role. The posting's location field lists Florida, while its description explicitly states that the position is fully remote within the U.S.
The published base salary range is $55,000–$65,000; the currency and pay period are not specified. Actual compensation considers experience, location, education, certifications, and skills. Equity is offered separately, along with opportunities for advancement, professional development, and employee learning programs.
Benefits
- Unlimited paid time off and 11 company holidays.
- Medical, dental, and vision coverage, plus Health Savings Account and Flexible Spending Account options.
- Long- and short-term disability coverage and an annual employee wellness stipend.
- A 401(k) plan, parental leave, and family planning support benefits.
- A company-issued laptop and annual work-from-home stipend.
- Commuter benefits where applicable.
The employer provides equal employment opportunity and does not discriminate on the basis of characteristics protected by applicable federal, state, or local law.