Credentialing and Payer Enrollment Manager
Affect Therapeutics
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Own and continuously improve the end-to-end credentialing and enrollment lifecycle for all providers across our operations
- Build scalable processes and documentation that support rapid company growth, new state/programmatic expansions, and evolving payer requirements
- Implement a systems-thinking approach to credentialing, ensuring workflows integrate cleanly with RCM, compliance, recruitment, finance, and clinical operations
- Evaluate and deploy new tools, data workflows, and automation opportunities to increase speed, accuracy, and visibility across credentialing processes
- Monitor KPIs, cycle times, and bottlenecks; develop and execute improvement plans
- Oversee all payer enrollment activities (Medicaid, Employer, Marketplace, and Medicare plans), ensuring timely and accurate submission, follow-through, and completion
- Maintain continuous compliance with payer, state, and federal standards—including revalidations, expirables, and recredentialing cycles
- Serve as the internal expert on credentialing requirements, payer nuances, and market-specific rules
- Maintain meticulous provider records, audit-ready documentation, and updated data across credentialing platforms and internal systems
- Lead a growing credentialing and payer enrollment team, ensuring accountability, quality, and operational discipline across 20+ states and growing
- Manage external credentialing vendors, including performance oversight, SLAs, and integration with internal workflows
- Troubleshoot issues, set priorities, and guide the team through high-volume or fast-changing periods
- Develop strategic relationships with payer representatives to accelerate enrollment cycles and resolve issues
- Serve as Affect’s main representative to payers regarding credentialing questions, escalations, and operational nuances
- Deliver clear, proactive communication to internal stakeholders about provider status, risks, and projected go-live timelines
- Produce regular executive-level reporting on credentialing timelines, enrollment progress, risk areas, and performance metrics
- Maintain dashboards or tracking systems that give leadership real-time visibility into enrollment status and throughput
- Partner closely with RCM, Finance, and Operations to troubleshoot enrollment/credentialing barriers impacting claims or reimbursement.
Requirements
- 5+ years of experience in healthcare credentialing or payer enrollment, ideally in a multi-state environment
- Proven success designing or managing scalable, systematized credentialing workflows
- Experience with credentialing software and data systems; ability to learn and implement new tools; familiarity with Verifiable is a plus
- Deep understanding of Medicaid and commercial payer credentialing requirements
- Strong organizational ability, operational rigor, and comfort managing many moving pieces simultaneously
- Exceptional communication and relationship-building skills—with both internal teams and stakeholders
- Ability to thrive in a fast-paced, rapidly changing environment, maintaining accuracy and composure under pressure
- Behavioral health familiarity is a plus, but not required.
Benefits
- Health insurance
- Remote work options
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
credentialingpayer enrollmentworkflow designdata workflowsKPI monitoringcompliance managementaudit documentationperformance metricscredentialing softwareautomation
Soft skills
organizational abilityoperational rigorcommunication skillsrelationship-buildingproblem-solvingteam leadershipstrategic thinkingadaptabilityattention to detailaccountability