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The Payer Operations Specialist will be responsible for the operational backbone of payer contracting across Medicaid and commercial payers at Babylist Health. This role ensures that payer contracts, licenses, and credentials are submitted accurately, loaded on time, maintained in good standing, and fully operational prior to go-live. This role is critical to enabling scale—reducing operational friction, minimizing controllable denials and AR, and ensuring Babylist Health captures the full value of newly won payer contracts.
Job Responsibility:
Maintain detailed documentation and renewal schedules for licenses, credentials, and payer requirements
Own requirements for and execution of site inspections across multiple office locations
Coordinate responses to payer and regulatory requests for information in the event of an audit or otherwise
Own the end-to-end payer onboarding process, ensuring payers are fully loaded prior to effective dates
Partner with Billing and Ops teams to ensure claims and billing workflows are configured correctly, EFT and remittance are set up, authorization and denial management processes are in place, and reimbursement rates are clearly articulated
Act as the operational point of contact during payer go-lives
Maintain ongoing compliance and good standing across 85+ payer contracts
Support contract amendments, renewals, and updates
Track payer performance indicators such as rejections/denials, AR aging, patient responsibility, and cancellation rates, escalating issues as needed
Work closely with Payer Leads, Legal, Finance, Billing, Ops, and CS teams
Ensure payer requirements are clearly documented and communicated internally
Support rate change implementations and contract conversions from third-party to direct relationships
Requirements:
3–6+ years of experience in payer operations, credentialing, or healthcare contracting
Experience across both Medicaid and commercial payers (strongly preferred)
Highly detail-oriented with strong project management skills and can manage multiple payer uploads and deadlines simultaneously
Strong cross-functional communication skills and can translate complex payer requirements for non-expert audiences
Scrappy and resourceful
Thrive in startup environments where you can build processes from scratch and aren't afraid of ambiguity
Comfortable and enthusiastic about working in an AI-forward environment where AI tools are part of daily operations
Embrace using technology to enhance your work while keeping people at the center
What we offer:
Competitive salary with equity and bonus opportunities
Company-paid medical, dental, and vision insurance
Retirement savings plan with company matching and flexible spending accounts
Generous paid parental leave and PTO
Remote work stipend to set up your office
Perks for physical, mental, and emotional health, parenting, childcare, and financial planning