Head of Credentialing & Enrollment (Multi-State Telehealth)

Define Ventures; Newark (DE); In loco; USD 120.000 - 180.000; Tempo pieno

Descrizione del lavoro

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

Descrizione del lavoro

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