New Manager, Payer Enrollment

As Payer Enrollment Manager, you’ll be a key leader in our credentialing and compliance operations. You’ll oversee both delegated and non-delegated credentialing processes, manage payer enrollment workflows, and ensure we meet accreditation and contractual requirements. This role requires close collaboration with internal stakeholders and external payer partners to scale processes, maintain compliance, and drive operational efficiency. Oversee and audit the performance of Credentialing Verification Organizations (CVOs), ensuring alignment with Spring Health’s standards and payer requirements. Lead audits and ongoing monitoring for delegated contracts, including preparation, execution, and response to corrective action plans (CAPs) as needed. Lead and manage all payer credentialing and enrollment functions across delegated and non-delegated arrangements. Ensure compliance with NCQA, CMS, state, and commercial payer credentialing requirements. Develop and optimize workflows for application submission, recredentialing, and ongoing monitoring. Serve as the primary point of contact for payer credentialing escalations, audits, and operational issues. Collaborate with Compliance, Product, and Revenue Cycle Management teams to ensure data accuracy and streamline processes. Track and analyze performance metrics related to credentialing and enrollment, identifying trends and opportunities for improvement. Support the development and ongoing refinement of internal policies, procedures, and audit-readiness documentation. Maintain detailed records and audit trails to support both internal reporting and external compliance.