Credentialing and Payer Contracting Lead (backed by Y Combinator, $5M+ ARR, $23M+ raised)
2 нед. назад
LeadRemote
Lead role managing credentialing and payer contracting for AI-driven healthcare delivery platform.
Обязанности
- We’re looking for a highly organized, detail-oriented Credentialing & Payer Contracting Coordinator to help clinicians move efficiently from onboarding to payer participation and billing readiness.
- You’ll coordinate provider credentialing, recredentialing, payer enrollment, and contracting workflows across commercial and government health plans. You’ll collect and maintain provider information, submit applications, follow up with payers, track agreements and effective dates, and ensure every open item reaches a clear resolution.
- We’re a fast-paced startup, so the right person is proactive, persistent, adaptable, and energized by building better processes as we scale. This is a non-clinical and non-legal role. You will not provide clinical or legal advice, sign agreements, negotiate outside approved parameters, or attest on behalf of a provider without documented authorization.
- Coordinate initial credentialing, payer enrollment, and recredentialing for new and existing clinicians.
- Collect, review, and organize provider documentation, including licenses, DEA registrations where applicable, malpractice coverage, CVs, education and work history, board certifications, W-9s, NPIs, taxonomy codes, disclosures, and attestations.
- Maintain accurate provider profiles in CAQH ProView, NPPES, PECOS, state Medicaid systems, commercial payer portals, and internal tracking systems.
- Prepare, submit, and track enrollment applications, roster additions, demographic changes, service-location updates, reassignment requests, terminations, and payer requests for additional information.
- Follow up consistently with payer representatives through phone, email, portals, and ticketing systems; document every interaction and escalate stalled or time-sensitive applications.
- Support the payer-contracting lifecycle, including network-interest submissions, contracting applications, agreement intake, fee-schedule organization, redline tracking, signature routing, amendments, and renewals.
- Route reimbursement, legal, and operational terms to the appropriate internal decision-makers for review and approval.
- Maintain a reliable source of truth for each provider and payer, including application status, participating plans, contract status, effective dates, rates, renewal dates, outstanding items, owners, and next follow-up dates.
- Coordinate with provider operations, revenue cycle, finance, legal, and billing teams to confirm that credentialing, contracting, roster loading, and billing setup are complete before a provider is marked ready to bill.
- Monitor licenses, attestations, recredentialing deadlines, contract renewals, and other expirations to prevent avoidable interruptions in payer participation.
- Investigate discrepancies across provider records, payer portals, contracts, directories, and internal systems, and drive each issue through verified resolution.
- Track turnaround times, aging applications, upcoming deadlines, payer bottlenecks, and operational risks through clear weekly reporting.
- Identify recurring issues and improve workflows through better templates, checklists, documentation, automation, and escalation paths.
- Protect provider information and any patient information encountered by following Legion’s privacy, security, and access-control requirements.
Условия
- Hourly Compensation: $5–$15 per hour
- Work Setup: Fully Remote
- Apply directly through Ashby:
Другое
- At , we believe everyone deserves fast, affordable, and world-class health care, and we’re developing the AI infrastructure to deliver it ourselves at world scale.
- Legion is building autonomous medical care (the AI doctor), starting with psychiatry. Our AI-native care-delivery platform currently automates 95% of the administrative work required for us to deliver direct patient care. We also recently became the first company ever to receive regulatory authorization to let AI prescribe psychiatric medications , allowing us to not only collapse health care’s admin costs but also its clinical labor costs— shifting this industry’s economics from humans to tokens.
- Our technical moat is hard to copy—we combine rich data, production AI, doctors in the loop , and end-to-end care operations to deliver measurably better care to a clinically complex patient population. This has helped us produce tens of thousands of total visits in just 2 years , all while holding ops costs flat and achieving industry-leading patient NPS and retention. While the last generation of healthcare startups made the existing system incrementally more efficient, Legion is rebuilding full-stack care delivery from first principles. Our vision? A 10X better patient experience that’s higher quality, less expensive, and more scalable than ever before. And a 10X better clinician experience that frees our providers to focus on what matters most: caring for patients.
- is backed by Y Combinator , leading venture capital firms, and founders from Function Health, Modern Health, Everly Health, Trusted Health, Clipboard Health, PatientPing, Sesame Care, Faire, EasyPost, and fuboTV.
- Join us as we build the future of health care: faster, higher-quality, and more affordable, powered by doctors and AI working together.
- Job Type: Contract
- Role Type: Credentialing & Payer Contracting Operations
- Ideal Experience Level: 2+ years
- Location: Fully Remote
- Work Hours: 8:00 AM–5:30 PM Central Time
- Proficient in spoken and written English.
- Exceptionally detail-oriented and able to identify inconsistencies across names, addresses, licenses, NPIs, TINs, taxonomy codes, and effective dates.
- Organized and comfortable managing multiple applications, contracts, deadlines, and payer conversations without losing track of details.
- Persistent and professional when following up with payers and resolving delayed or incomplete applications.
- Proactive about identifying risks and escalating issues before they affect provider launches, network participation, or billing.
- A quick learner who can adapt to new payer requirements, systems, and internal processes.
- Comfortable working in a fast-paced startup where processes are continuously evolving.
- Skilled at maintaining clear documentation and ensuring every open item has an owner, status, next step, and follow-up date.
- Trustworthy with sensitive information and disciplined about authorization, attestations, signatures, and access controls.
- 2+ years of experience in provider credentialing, payer enrollment, contract administration, provider operations, medical-staff services, revenue-cycle operations, or related healthcare administration.
- Hands-on experience with CAQH ProView, NPPES, PECOS, Availity, state Medicaid systems, or commercial payer portals.
- Familiarity with initial credentialing, recredentialing, roster management, provider demographic changes, and payer effective-date verification.
- Experience supporting payer contracting, fee-schedule review, contract routing, amendments, or network-development workflows is strongly preferred.
- Behavioral health, telehealth, or multi-state provider-network experience is a plus.
- CPCS or another credentialing certification is a plus, but not required.
- The most important qualifications are operational ownership, accuracy, persistent follow-through, and clear communication.