Manager, Payer Enrollment

Summary

Join Spring Health as a Payer Enrollment Manager and become a key leader in credentialing and compliance operations. Oversee delegated and non-delegated credentialing processes, manage payer enrollment workflows, and ensure compliance with accreditation and contractual requirements. Collaborate with internal stakeholders and external payer partners to scale processes, maintain compliance, and drive operational efficiency. This role involves auditing CVO performance, leading audits for delegated contracts, managing payer credentialing functions, ensuring compliance with various regulations, developing and optimizing workflows, serving as the primary point of contact for escalations, collaborating with other teams, tracking performance metrics, and supporting policy development. Success in this role will be measured by shortened application processing timelines, high compliance rates, timely resolution of escalations, strong collaboration, and implementation of scalable processes. The position offers a competitive salary and benefits package.

Requirements

• 5+ years of experience in healthcare credentialing, payer enrollment, or provider network operations
• Deep knowledge of NCQA standards, CAQH, Medicare/Medicaid enrollment, and delegated credentialing structures
• Experience managing CVOs and auditing third-party credentialing processes
• Proven ability to develop and optimize credentialing workflows and policies
• Strong communication and stakeholder management skills, especially when working with payers, compliance teams, and leadership
• Analytical mindset with experience in data tracking, reporting, and operational performance monitoring
• Comfortable working in fast-paced environments and balancing multiple priorities

Responsibilities

• 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

Preferred Qualifications

• NAMSS Certification (CPMSM or CPCS) preferred
• Experience implementing credentialing technology and automation tools
• Background in payer contract management and compliance audits

Benefits

• Health, Dental, Vision benefits start on your first day at Spring
• You and your dependents also receive access to One Medical accounts
• HSA and FSA plans are also available, with Spring contributing up to $1K for HSAs, depending on your plan type
• Employer sponsored 401(k) match of up to 2% for retirement planning
• A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents
• We offer competitive paid time off policies including vacation, sick leave and company holidays
• At 6 months tenure with Spring, we offer parental leave of 18 weeks for birthing parents and 16 weeks for non-birthing parents
• Access to Noom, a weight management program—based in psychology, that’s tailored to your unique needs and goals
• Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses
• Access to Wellhub, which connects employees to the best options for fitness, mindfulness, nutrition, and sleep in one subscription
• Access to BrightHorizons, which provides sponsored child care, back-up care, and elder care
• Up to $1,000 Professional Development Reimbursement a year
• $200 per year donation matching to support your favorite causes