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Payer Operations Specialist

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Babylist

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Location:
United States

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Contract Type:
Not provided

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Salary:

85075.00 - 102090.00 USD / Year

Job Description:

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

Additional Information:

Job Posted:
February 04, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:

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