Credentialing & Enrollment Lead

Mira Mace; Newark (DE); In loco; USD 120.000 - 180.000; Tempo pieno

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Mira Mace is seeking a Credentialing & Enrollment Lead to own the multi-state enrollment strategy for a telehealth-first Medicare navigation company. You will shape payer relationships, contracting, and multi-state enrollment, collaborating with founders and the COO to build scalable credentialing infrastructure and enrollment playbooks.

This strategic role offers ownership, direct access to leadership, and the opportunity to scale enrollment operations across new states while ensuring

Competenze

• Multistate telehealth credentialing experience (not just single-location enrollment).
• Understanding PC-MSO structures and their impact on payer enrollment.
• Direct experience with Medicare Advantage payers and state Medicaid programs.
• Familiarity with CAQH, PECOS, and multiple state Medicaid portals.
• Experience with payer contracting and post-credentialing negotiations.
• Ability to work independently and bring answers, not just questions.
• Comfort in a small, fast-moving team with leadership access.
• Bonus: delegated credentialing, MAC jurisdictions, or EDI enrollment.

Mansioni

• Own provider enrollment end-to-end across MA, Medicaid, and Original Medicare in multiple states.
• Lead credentialing strategy using CAQH, PECOS, and state portals.
• Navigate payer contracting, understand fee schedules and timelines.
• Build a playbook by documenting enrollment processes.
• Troubleshoot stalled or denied applications and correct filings.
• Advise on structure: PC-MSO, telehealth, and multi-state licensure interactions with enrollment.

Conoscenze

Multistate credentialing

PC-MSO structures

Medicare Advantage experience

State Medicaid portals

Payer contracting

Independent ownership

Leadership in small teams

Delegated credentialing

EDI enrollment

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What we're looking for

We're looking for a Credentialing & Enrollment Lead who can own our multi-state provider enrollment strategy end-to-end. You'll be the person who tells us what to do — not the other way around.

We're a telehealth-first Medicare navigation company operating through a PC-MSO structure across multiple states. We've built the product and the clinical team. Now we need someone who deeply understands the credentialing and payer enrollment landscape to unblock our ability to serve Medicare Advantage and Medicaid patients at scale.

You'll work directly with the founders and report to the COO. This isn't a "process applications and wait" role — it's a strategic hire where you'll shape how we approach payer relationships, contracting, and multi-state enrollment.

We're a small, focused team, and this role will have a direct impact on our payer strategy, enrollment operations, and ability to scale to new states. You'll collaborate closely with leadership and our clinical team to build the credentialing infrastructure that lets us actually serve patients.

This is a full-time role, but we're open to part-time or contract arrangements for the right person. If you have deep expertise and limited availability, we'd still love to talk.

Responsibilities

• Own provider enrollment end-to-end. MA, Medicaid, and Original Medicare across multiple states — applications, follow-ups, and issue resolution.

• Lead credentialing strategy. CAQH, PECOS, state Medicaid portals — you know what needs to happen and in what order.

• Navigate payer contracting. Understand fee schedules, contracting timelines, and what's negotiable.

• Build the playbook. Document processes so enrollment doesn't live in anyone's head.

• Troubleshoot and escalation. When applications stall, get denied, or get filed incorrectly — you know how to fix it.

• Advise on structure. Understand how PC-MSO structures, telehealth, and multi-state licensure interact with enrollment.

Qualifications

• You've done multi-state telehealth credentialing before — not just in-person, single-location enrollment.

• You understand PC-MSO structures and how they affect payer enrollment.

• You've worked with Medicare Advantage payers and state Medicaid programs directly.

• You know CAQH, PECOS, and at least a few state Medicaid portals inside and out.

• You've dealt with payer contracting — you know what happens after credentialing.

• You can operate independently — we need someone who brings the answers, not just the questions.

• You're comfortable in a small, fast-moving team where you'll have real ownership and direct access to leadership.

• Bonus: experience with delegated credentialing, MAC jurisdictions, or EDI enrollment.

Why join us

• Mission with meaning. We're building something that makes healthcare a significantly less painful for real people. When we get it right, we help someone when they need it most avoid thousands in unnecessary medical costs — or get care they might otherwise miss.

• High ownership. You'll define how we approach payer enrollment from the ground up.

• Real impact. Every enrollment you unblock directly translates to patients we can serve.

• Grow with us. Build and lead the credentialing function as the company scales.

• Meaningful early equity. Real ownership in what we're building.

About Us

At Mira Mace, we're building an AI-powered healthcare assistant that helps people navigate one of the most confusing systems out there.

We've felt the pain ourselves — the endless back-and-forth with insurance, surprise bills, and the lack of clarity when you just need answers. Too many people fall through the cracks, and we're determined to change that.

Our goal is simple: give people a trusted advocate who can make healthcare less exhausting and more human.

Our founding team brings a mix of strong technical experience from companies like Microsoft, Google, and Meta, along with serial startup experience ranging from early bootstrapped ventures to Series D scale-ups. We're early, focused, and building with urgency and care.