Senior Credentialing & Payer Operations Lead

Nadia Care; Newark (NJ); On-site; USD 80,000 - 90,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Stock Option Grant

Disability Insurance

Time Off

Job summary

Nadia Care is seeking a Credentialing & Payer Operations Manager to own end-to-end provider licensing, payer enrollment, and credentialing operations. This hands-on role builds scalable internal processes, maintains strict regulatory compliance, and drives fast time-to-credentialing metrics.

Starting as a one-person team, it will bridge providers with health plans, billing, and client success teams. You will establish foundational workflows for the Care Team (including doulas), track KPI-driven

Qualifications

• 5+ years of healthcare credentialing, provider operations, and payer enrollment experience.
• Experience submitting initial state licensure applications across multiple states and tracking CEU requirements.
• Bachelor’s degree in Healthcare Administration, Business, or related field (Associates accepted with equivalent hands-on experience).

Responsibilities

• Manage full lifecycle licensing, credentialing, and re-credentialing applications for Care Team members across multiple states.
• Build and execute Doula Readiness workflows to onboard non-traditional providers into payer networks.
• Collect, audit, and verify primary source documentation for payor and state credentialing packages.
• Directly communicate with providers to gather missing documentation and guide renewal procedures.
• Proactively monitor credentials, license expirations, and CEU requirements using Medallion.
• Establish, standardize, and optimize credentialing and payer enrollment processes from scratch.
• Oversee credentialing-to-claims linkage and collaborate with billing/RCM to prevent denials.
• Monitor regulatory changes and ensure client-facing compliance reporting.

Skills

Provider operations

Payer enrollment

Credentialing

Regulatory compliance

CEU tracking

Education

Bachelor's degree in Healthcare Administration, Business, or related field

Tools

Medallion

Job description

Nadia Care is seeking a Credentialing & Payer Operations Manager to own end-to-end provider licensing, payer enrollment, and credentialing operations. This hands-on role builds scalable internal processes, maintains strict regulatory compliance, and drives fast time-to-credentialing metrics.

Starting as a one-person team, it will bridge providers with health plans, billing, and client success teams. You will establish foundational workflows for the Care Team (including doulas), track KPI-driven