Contracting & Credentialing Manager

Kemet Health is seeking a laser-accurate, process-driven Contracting & Credentialing Manager to own payer enrollment, network contracting, and ongoing roster management across our growing multi-state footprint. As the point person for payor relationships, you'll shorten time-to-revenue, reduce denials tied to enrollment, and keep our clinicians fully credentialed and ready to serve patients.

About Kemet Health: We are an outpatient multi-specialty healthcare organization operating twenty virtual and physical outpatient clinics nationwide and expanding access to other states. We focus on relationship-based care and operate a multi-lingual practice, with new services added monthly and multiple insurance plans accepted. Our core focus areas include:

• Psychiatry & Psychotherapy
• Primary Care
• Endocrinology
• Gynecology
• Adults & Adolescents
• Outpatient care via telehealth and clinics

Location

Virtual (fully remote)

Role Overview

You will lead end-to-end payer contracting and credentialing for both individual providers and group/facility entities (new clinics, new states, new service lines). You'll negotiate rates, manage portals, maintain perfect rosters, and partner closely with RCM, Compliance, and Operations to ensure clean billing and fast reimbursement.

Key Responsibilities

Payer Contracting & Rate Management

• Source, negotiate, and execute commercial and government payer agreements (United, Aetna, Cigna, TriCare East and West, national and regional plans).
• Analyze and validate fee schedules; load/verify rates with RCM; monitor underpayments and initiate escalations.
• Maintain a central contract repository with terms, effective dates, carve-outs, and termination/renewal controls; own a 90/60/30-day renewal calendar.
• Support value-based, case-rate, and telehealth reimbursement models; ensure correct POS/telehealth modifiers and policy alignment.

Credentialing, Enrollment & Revalidation

• Own CAQH (group & individual) accuracy, completeness, and attestation cadence.
• Manage PECOS, NPPES (NPI1/NPI2) enrollments, revalidations, and recredentialing cycles; complete facility and group enrollments when opening new locations.
• Handle payer portals (e.g., Availity, NaviNet, OneHealthPort, Change Healthcare, plan-specific portals) for submissions, EDI/ERA/EFT setup, and demographic updates (TIN, NPI, taxonomy, practice addresses).
• Coordinate primary source verification and manage expirables: state licenses, DEA, CDS, board certification, malpractice COIs, BLS/ACLS, CLIA (if applicable).

Rosters, Demographics & Change Management

• Maintain real-time, audit-ready rosters by payer and state; process adds/terms/LOA rapidly with documented confirmations.
• Drive location/service expansion packets (letters of intent, W-9, W-8 if needed, malpractice, lease/utilities where required) for new clinics or telehealth service areas.
• Ensure taxonomy/POS alignment for programs like TMS, Women's Health, CCM/CoCM, and Endocrinology.

Denial Prevention & Revenue Enablement

• Partner with RCM to track and remediate enrollment-related denials; resolve clearinghouse enrollment issues; ensure payer IDs and EDI enrollments are complete before go-live.
• Publish onboarding checklists per role (MD/DO, NP/PA, Psychologist, MA) and per payer; run weekly cross-checks against first-claim readiness.

Compliance & Audit Readiness

• Align workflows with NCQA standards, HIPAA, state rules, and payer policies; prepare documentation for audits and site reviews.
• Maintain SOPs, templates, and checklists; lead periodic internal audits.

KPIs & Reporting

• Time-to-Credential (TTC) per payer and state
• % of active clinicians fully enrolled on target panels
• Denial rate due to credentialing/enrollment (goal: trending to zero)
• Contract turnaround time; percentage of contracts with verified fee schedules loaded
• On-time recredentialing & revalidation rate (goal: 100%)

Provider and Administration Onboarding

• Register new providers with payers
• Manage initial onboarding for administrators
• Light HR function guiding new employees through onboarding
• Work with management to optimize these processes

Required Qualifications

• 4+ years hands-on payer contracting and credentialing experience in multi-state outpatient or telehealth settings
• Mastery of CAQH, PECOS, NPPES, Medicaid/MCO enrollments, and major payer portals; proven success negotiating commercial rates
• Strong Excel/Google Sheets skills (vlookup/index-match, pivot tables) for fee analysis and KPI reporting
• Superb documentation discipline; comfort managing high-volume, deadline-driven queues
• Excellent cross-functional communication (RCM, Compliance, Finance, Clinical Ops)

Preferred Qualifications

• Experience with credentialing platforms (e.g., Modio, Silversheet, VerityStream) and EHR/PM systems
• Familiarity with Tricare/Humana Military, VA CCN, and Medicaid managed care nuances
• Working knowledge of CPT/HCPCS, telehealth POS/modifiers, EDI/ERA/EFT enrollments
• Multistate experience (VA/MD priority; additional states a plus); multilingual skills a plus

What We Look For

• Meticulous, highly detail-oriented operator who loves clean data and clear processes
• Proactive problem-solver who surfaces risks early and proposes solutions
• Confident negotiator with high EQ who builds durable payer relationships
• Builder's mindset—comfortable creating SOPs, dashboards, and scalable systems
• Mission alignment: expanding timely access to affordable, relationship-based care

Job Type

Full-time (flexible schedule available)

Pay

$40,000 – $64,000 per year (commensurate with experience) + performance bonus tied to KPI achievement

Benefits

• 401(k)
• Health, dental, and vision insurance
• FSA/HSA options
• Paid time off and parental leave
• Professional development stipend
• Malpractice/COI administration support
• Remote work with occasional travel

Work Setting

Remote with cross-functional collaboration; weekly operations/RCM syncs; documented SLAs for ticket intake and turnaround

Schedule

Monday–Friday business hours with flexibility for payer meeting windows across time zones

• Join Kemet Health to build a best-in-class contracting and credentialing function that accelerates access, reduces denials, and powers our clinicians to care for more patients, faster.

Job Type: Full-time

Pay: $40, $64,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending