Credentialing & Enrollment Lead

Mira Mace; United States; Remoto; USD 120.000 - 180.000; Tempo pieno

Vantaggi offerti da questo lavoro

Equity

Impact on patient care

Descrizione del lavoro

Mira Mace, Inc. is building an AI-powered healthcare assistant to simplify navigating the healthcare system.

We are seeking a provider enrollment lead to own end-to-end enrollment for Medicare Advantage, Medicaid, and Original Medicare across multiple states, guiding credentialing strategy with CAQH, PECOS, and state portals. The role requires deep familiarity with PC-MSO structures, payer enrollment impacts, and experience with Medicare Advantage payers and state Medicaid programs.

Competenze

• Experience with multi-state telehealth credentialing.
• Understanding of PC-MSO structures and their effect on payer enrollment.
• Direct experience with Medicare Advantage payers and state Medicaid programs.
• Proficiency with CAQH, PECOS, and state Medicaid portals.
• Experience with payer contracting processes.
• Ability to operate independently in a fast-moving startup environment.

Mansioni

• Own provider enrollment end-to-end for Medicare Advantage, Medicaid, and Original Medicare across multiple states.
• Lead credentialing strategy using CAQH, PECOS, and state Medicaid portals.
• Navigate payer contracting, including fee schedules and contracting timelines.
• Build and document the enrollment playbook and processes.
• Troubleshoot and resolve stalled or denied applications.
• Advise on how PC-MSO structures and telehealth interact with enrollment.

Conoscenze

Credentialing leadership

CAQH/PECOS

Medicare/Medicaid enrollment

Payer contracting

Telehealth credentialing

Independent work

Strumenti

CAQH

PECOS

Descrizione del lavoro

About the Company

Mira Mace is building an AI-powered healthcare assistant that helps people navigate the complexities of the healthcare system. Our goal is to provide a trusted advocate to make healthcare less exhausting and more human, helping patients avoid unnecessary costs and access the care they need.

Responsibilities

• Own provider enrollment end-to-end for Medicare Advantage, Medicaid, and Original Medicare across multiple states
• Lead credentialing strategy using CAQH, PECOS, and state Medicaid portals
• Navigate payer contracting, including fee schedules and contracting timelines
• Build and document the enrollment playbook and processes
• Troubleshoot and resolve stalled or denied applications
• Advise on how PC-MSO structures and telehealth interact with enrollment

Requirements

• Experience with multi-state telehealth credentialing
• Understanding of PC-MSO structures and their effect on payer enrollment
• Direct experience with Medicare Advantage payers and state Medicaid programs
• Proficiency with CAQH, PECOS, and state Medicaid portals
• Experience with payer contracting processes
• Ability to operate independently in a fast-moving startup environment

Preferred Qualifications

• Experience with delegated credentialing
• Knowledge of MAC jurisdictions
• Experience with EDI enrollment

Benefits

• High ownership and ability to define functions from the ground up
• Real impact on patient care and company scaling
• Meaningful early equity