Payer Operations Specialist

Job Summary

As a remote full-time Payer Operations Specialist, the successful candidate will manage payer expansion processes, investigate stalled applications, and ensure quality control in credentialing and enrollment workflows.

Key responsibilities

• Document and maintain end-to-end SOPs for payer contracting, enrollment, and credentialing workflows
• Implement quality controls to reduce rework and rejected applications while identifying bottlenecks in the expansion pipeline
• Conduct proactive follow-ups with payers to confirm application receipt and resolve deficiencies until approval is achieved

Required qualifications

• 2+ years of experience in provider enrollment, credentialing, payer contracting, or healthcare administration
• Experience in building or documenting processes and SOPs
• Ability to manage metrics and report on pipeline throughput
• Highly independent with a relentless follow-up approach and strong organizational skills
• Exceptional attention to detail and pride in delivering accurate, deadline-driven work