Team Lead Payor Enrollment and Credentialing (Remote)

-This is a fully remote position for anywhere in the United States.-
About CertifyOS:
We are on a mission to change how the US healthcare industry deals with provider data. Our goal is to reduce the cost of healthcare by streamlining access to provider data and reducing administrative and regulatory burdens on healthcare organizations.
CertifyOS is revolutionizing the healthcare industry by laying the infrastructure upon which the next generation of provider-centric applications (network adequacy, accuracy, provider utilization, etc.) will be built. As innovative digital health plans and provider care models continue to scale and challenge traditional care models, the need for a centralized data infrastructure has never been greater. Our platform will support the future of healthcare innovation by becoming the source of truth of provider data, and making that data easily accessible and actionable for the entire healthcare ecosystem.
We have built an API-first, UI-agnostic, end-to-end provider network management platform automating licensing, enrollment, credentialing, and network monitoring. With direct integrations into 100's of primary sources, we are uniquely positioned to enhance visibility into the entire provider network management process. Our team has more than 25+ years of combined experience building provider data systems at Oscar Health and are backed by top-tier VC firms who share our vision of creating a one-of-a-kind healthcare cloud that removes the friction surrounding provider data..
At CertifyOS, we pride ourselves on fostering a meritocratic environment that ensures every voice has an opportunity to be heard. Founded on the principles of trust, transparency and accountability, we aim to challenge the status quo at every step and are looking for purpose-driven team members to share our journey in redefining the Healthcare data infrastructure.
About the role:
We are looking for our next core team member to join the Payor Enrollment team! You will play an integral part in ensuring the timely and accurate processing of network enrollment applications. As an employee joining the ground floor of this early-stage start-up, you'll play a key role in helping to design and execute the infrastructure of this growing team. This is a fully remote role and will report to the Manager of Payor Enrollment.
What you'll do:

• Respond professionally and with urgency to customers' inquiries regarding the status of enrollment applications.
• Execute administrative duties, including maintaining lists of payer application statuses, prepare reports on in-network payers, and assist operations in answering questions on payer status
• Nurture relationships with CertifyOS' customer base and with payers, review or craft credentialing applications appeal letters, build relationships with the credentialing departments within the payer organization to gain contracts
• Manage payer contracts, including tracking contract status, generating reports on in-network payers, and providing support in response to questions on payer status
• Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and team work with departments, vendors, etc
• Supervises the daily operational needs and services related to the payer enrollment process and represent CertifyOS' interests to all types of payers including federal and state government agencies/programs, and commercial insurance carriers
• Lead a team of Analyst in the day-to-day operations of payor contracting and provider credentialing from document gathering to submission to approval including creating processes enhancements and performance management
• Provide feedback regarding potential changes or enhancements to improve staff performance and ensure work quality has a positive impact

What you'll need:

• Minimum of 3 years experience in payer contracting and credentialing, including application submission and contract negotiation
• Minimum of 2 years experience leading teams
• Demonstrated knowledge and understanding of healthcare industry, legal and regulatory requirements
• Expert knowledge of state medicaid, medicare, and commercial payer plans; experience with hospital privileging and prescriptive authority a plus
• Exceptional attention to detail and accuracy in all work, with a commitment to producing high-quality results
• Strong organizational and administrative skills, with the ability to manage multiple project simultaneously and meet deadlines
• Excellent communication skills, including the ability to write clear and concise correspondence and engage with a variety of stakeholders
• Willingness to learn new skills and adapt to a fast-paced, rapidly changing environment

Benefits of working at CertifyOS:

• Unlimited PTO policy with a mandatory minimum of two weeks off
• No meeting Thursdays so you can stay heads down to get work done
• 100% of health, dental, and vision insurance premiums covered for employees
• Remote work first, preference for eastern and central time zones