Enrollment Operations Specialist III

Role Overview

• Manage end-to-end delegated credentialing operations across an assigned portfolio of payors, including pre-delegation audits, ongoing compliance, quarterly reporting, and annual audits
• Serve as the primary point of contact for delegated payor relationships, handling communications, data requests, and issue resolution with cross-functional teams
• Prepare, coordinate, and execute both pre-delegation and annual credentialing audits, ensuring documentation, files, and processes meet NCQA and payor-specific standards, and resolve any Corrective Action Plans identified during audits
• Develop and maintain audit-ready credentialing files, including primary source verification documentation, credentialing committee records, and adverse action tracking
• Build and deliver reporting packages for submission to delegated entities & payors, including monthly delegated rosters, annual audits, and credentialing activity summaries on required cadences
• Coordinate with internal stakeholders (enrollment, partnerships, RCM, legal & compliance, special projects) to ensure provider data is accurate and current across systems, and perform regular roster reconciliations with delegated entities
• Assist in the review and expectations of new Delegated Contract Agreements and implement processes to meet new DCA obligations
• Track regulatory and accreditation changes (NCQA, state-specific requirements) to ensure compliance with regulatory guidelines & industry standards

Requirements

• You have 2-5 years of enrollment or credentialing experience, with at least 2 years of experience with delegated credentialing
• You have working knowledge of NCQA credentialing standards
• You’ve demonstrated experience preparing for and participating in delegated credentialing audits
• You have the ability to manage multiple payor relationships and deadlines simultaneously without close supervision
• You have high attention to detail with strong documentation habits
• You’re comfortable working cross-functionally and communicating clearly with both operational peers and payor contacts
• You have experience in a high-growth or tech-enabled healthcare environment (preferred); telehealth or behavioral health background is a plus

Benefits

• Comprehensive Health Coverage: Medical, dental, and vision insurance, plus life and disability coverage.
• Parental Leave & Family Support: Up to 18 weeks paid leave and a new child stipend.
• Financial Wellness: 401(k) program and equity opportunities.
• Meals & Home Office Support: Stipends for home office setup and ongoing funds for meals, with tailored perks for both remote and in-office employees.
• Time Off to Recharge: Flexible PTO, 12 paid holidays, and a full winter break week.
• Wellness & Development: Annual stipends to put towards personal & professional growth.
• Mental & Physical Health Support: No-cost access to therapy through the Grow platform, weekly flexible hours for self-care (“Mental Health Mornings/Afternoons”) and memberships to leading wellness apps (such as One Medical, Headspace, and Talkspace).
• Extra Perks: Pet insurance discounts, commuter benefits, and global travel assistance.