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Payer Enrollment Specialist

Role overview

Summary

This role focuses on managing payer enrollments and re-enrollments for clinicians at Pomelo Care. You will collaborate with various teams to streamline processes and support new clinical hires, contributing to the company's mission of improving maternal and child health.

Qualifications

  • 3+ years healthcare operations experience, ideally within healthcare delivery or a high-growth startup.
  • Experience with payer credentialing for roles including APPs, therapists, registered dietitians, physicians, and doulas with Medicaid managed care plans.
  • Experience enrolling clinicians in state Medicaid.
  • Exceptional project management and prioritization skills.
  • Meticulous attention to detail.

Responsibilities

  • Own the end-to-end process for enrolling new providers with health plan partners.
  • Work closely with new clinical hires and a third-party vendor to manage license applications and renewals.
  • Partner with the Licensing, Credentialing, and Enrollment team to enroll providers with payers.
  • Identify opportunities to improve licensing, payer credentialing, and enrollment processes.

Key facts

  • Remote from: United States
  • Full time
  • Mid-level (2-5 years)
  • Enrollment Advisor
  • $55K – $65K / year
  • English

Hard skills

Other skills

  • Detail Oriented
  • Results Focused
  • Problem Solving

About the company

Pomelo Care logo

Pomelo Care

  • Digital Health
  • Startup
  • 11–50
At Pomelo Care, we believe every pregnant person and newborn should receive high quality, accessible and personalized care. That's why we're combining evidence-based care with technology to improve outcomes for families.

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Job description

Pomelo Care is the leading virtual medical practice for women and children, providing care across pregnancy, postpartum, pediatrics, menopause, and perimenopause. We combine proactive, 24/7 clinical care with technology that helps us reach patients earlier, identify risks sooner, and deliver personalized care throughout their journey. Our team includes clinicians, technologists, operators, and problem-solvers working together to make high-quality care more accessible for families nationwide.

About the Role

Your North Star: Manage payer enrollments, and payer re-enrollments across clinician types for our existing and new markets. Reporting to the Payer Enrollments Manager, in this role, you will have the following responsibilities:

What You’ll Do

  • Own the the end-to-end process for enrolling new providers with our health plan partners, supporting newly hired clinicians on all requirements for licensing, credentialing, and enrollment

  • Work closely with new clinical hires and our third-party vendor to manage new license applications and license renewals

  • Partner with the Licensing, Credentialing, and Enrollment team to enroll providers with payers across existing and new markets

  • Identify opportunities to improve our licensing, payer credentialing, and enrollment processes to shorten the time for clinicians to start seeing patients

Who You Are

  • 3+ years healthcare operations experience, ideally having worked within healthcare delivery or a high-growth startup

  • Experience with payer credentialing for roles including APPs, therapists, registered dietitians, physicians, and doulas with Medicaid managed care plans

  • Experience enrolling clinicians in state medicaid

  • Exceptional project management and prioritization skills

  • Experience building and scaling operational processes for clinicians

  • Results-oriented operator who moves fast

  • Meticulous attention to detail

  • Comfort with ambiguity

  • Ability to work cross-functionally with clinicians and technical teams

  • Passionate about maternal and child health

Compensation

The expected base salary range offered for this role is $55,000-$65,000. This role is also eligible for equity, giving you an ownership stake in Pomelo’s mission. Actual compensation may vary based on relevant experience, skills, competencies, and certifications.

Benefits and Perks

By joining Pomelo, you’ll get in on the ground floor of a fast-moving, well-funded startup on a mission to improve outcomes for all mothers and babies. We cultivate a collaborative, patient-first environment where data drives our decisions and team members are challenged to learn, grow, and have fun together. We also offer:

  • Comprehensive Health, Dental, and Vision coverage for employees and their families

  • High deductible Health Plans with Health Savings Account (HSA) options

  • Flexible Spending Account (FSA)

  • Equity grant participation

  • 401(k) program

  • Competitive vacation policy

  • 16 weeks paid parental leave

  • Fully remote work flexibility (within the US) with offices in NYC and SF for those who prefer in-person work

We are committed to hiring the best team to improve outcomes for all mothers and babies. To solve the complex challenges facing the diverse population we serve, we need diverse perspectives, actively welcoming people of all races, ages, sexual orientations, gender identities and expressions, national origins, religions, disabilities, and veteran statuses. We strive to cultivate an inclusive and respectful environment where team members thrive by working across disciplines, moving fast, making data driven decisions, learning continuously, and always putting the patient first.

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