Specialist III, Enrollment Operations (Healthcare)

TL;DR

Specialist III, Enrollment Operations (Healthcare): Managing the full lifecycle of delegated credentialing agreements with health insurance payors with an accent on compliance, NCQA standards, and audit processes. Focus on executing pre-delegation and annual audits, maintaining audit-ready files, and managing complex payor relationships.

Location: Remote (Must be based in the US)

Salary: $28.84 per hour

Company

hirify.global is a technology-powered marketplace connecting therapists with patients and augmenting insurance payors to increase accessibility to mental healthcare.

What you will do

• Manage end-to-end delegated credentialing operations for a portfolio of payors, including pre-delegation audits and quarterly reporting.
• Act as the primary point of contact for delegated payor relationships, handling communications and data requests.
• Execute pre-delegation and annual audits to ensure documentation meets NCQA and payor-specific standards.
• Develop and maintain audit-ready credentialing files, including primary source verification and committee records.
• Build and deliver reporting packages such as monthly delegated rosters and credentialing activity summaries.
• Coordinate with internal legal, compliance, and RCM teams to ensure provider data accuracy across systems.

Requirements

• 2-5 years of enrollment or credentialing experience.
• At least 2 years of direct experience with delegated credentialing.
• Working knowledge of NCQA credentialing standards.
• Proven experience preparing for and participating in delegated credentialing audits.
• Must be based in the United States.

Nice to have

• Experience in a high-growth or tech-enabled healthcare environment.
• Background in telehealth or behavioral health.

Culture & Benefits

• Comprehensive medical, dental, and vision insurance, plus life and disability coverage.
• 401(k) program and equity opportunities.
• Up to 18 weeks paid parental leave and a new child stipend.
• Flexible PTO, 12 paid holidays, and a full winter break week.
• Stipends for home office setup, meals, and professional development.
• Mental health support including no-cost therapy and memberships to wellness apps.