Payer Operations & Credentialing Coordinator

Payer Operations & Credentialing Coordinator

Full-time • New Mexico / Colorado • Reports to: Senior Manager, Quality & Performance Systems

Onsite Expectations: For employees based in the Denver, CO area, this role requires working onsite 3 days per week.

About FronteraCare and the Role

FronteraCare is committed to providing exceptional ASD diagnostic evaluation and ABA services to families across several regions but largely in rural New Mexico. The Payer Operations Coordinator supports the Payer Operations & Credentialing team across insurance benefit verification, prior authorization, credentialing, and payer enrollment workflows — the administrative backbone that ensures families can start and continue care without delay.

This role supports both the Medicaid and the commercial insurance benefit verification process and provides day-to-day support across the team’s core functions. Because benefit verification and active payer enrollment are prerequisites for prior authorization, scheduling, and treatment start dates, the accuracy and speed of this work directly affects patient access to care. This is an excellent entry point into healthcare payer operations, with a clear growth path in authorizations, billing, or credentialing.

Responsibilities

Insurance Benefit Verification

• Support the Medicaid and commercial insurance benefit verification process: contact payers by phone and portal to verify eligibility, benefits, copays, deductibles, coinsurance, out-of-pocket maximums, telehealth coverage, covered places of service, visit limits, network participation, and prior authorization requirements.
• Verify and document primary and secondary coverage, including coordination of benefits, for both commercial and Medicaid plans.
• Complete verifications within defined turnaround times so evaluation and treatment start dates are not delayed.
• Document benefit details and payer communications accurately in the EHR and tracking systems.
• Communicate verification results, coverage limitations, or other payer concerns to Intake, Scheduling, Authorization, Clinical, and Billing teams.

Prior Authorization & Payer Support

• Support prior authorization submissions, renewals, and payer follow-up.
• Assist with insurance research, payer escalations, and claim-related inquiries.
• Help maintain accurate authorization records and setup in the EHR.
• Monitor payer policy updates and flag changes that may impact service delivery or reimbursement.

Credentialing & Payer Enrollment

• Maintain accurate credentialing and licensing records for BCBAs, RBTs, and Psychologists across operating states, keeping certification documents (e.g., RBT certification letter, BACB RBT Attestation, CPR certification, TB results) on file as they are received.
• Update credentialing records once notified of a new certification by the assistant lead or training team, then monitor certification, license, and CPR due dates annually going forward — sending timely renewal reminders to providers and leadership ahead of expiration.
• Assist with credentialing and licensing applications, including gathering and organizing required documentation.
• Support payer enrollment for BCBAs, RBTs, and Psychologists — including credentialing forms, CAQH profile maintenance, Medicaid provider account setup, and monitoring the status of individual payer applications.
• Verify the correct NPI is on file for each provider, including as part of Medicaid Cultural Competency compliance tracking.
• Maintain audit-ready credentialing and enrollment documentation, and assist in assembling records for payer or state regulatory audits.

Team & Administrative Support

• Run recurring daily operational checks, including morning reminders to clinical staff on unfinished session notes.
• Maintain Rippling onboarding task templates, documents, and automated emails as they relate to credentialing and payer enrollment requirements; accept pending applicants and review onboarding plans to confirm required stakeholders are included.
• Support documentation of standard operating procedures and playbooks for payer operations workflows.
• Perform other administrative duties supporting the Payer Operations team as assigned.

What This Role Does Not Own

• This role is scoped deliberately narrowly so that credentialing and payer enrollment work is not diluted by training and onboarding coordination. The following sit with the Training & Onboarding function:
• New hire onboarding calls, including first-day logistics, availability confirmation, location details, and general new hire questions.
• The RBT application and competency process, including competency assessments and certification exam scheduling. This role engages after the exam is passed.
• Initial entry of certification numbers and expiration dates; the assistant lead enters this information and notifies credentialing, which then updates records and owns ongoing monitoring.
• Creating Passage Health provider profiles and the initial NPI and taxonomy setup.

Qualifications

• High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred.
• 1+ year of experience in healthcare administration, insurance verification, medical billing, prior authorizations, credentialing, or a patient-facing healthcare support role.
• Working knowledge of commercial insurance and Medicaid plans, including primary vs. secondary coverage, copays, deductibles, and coinsurance.
• Strong phone communication skills and the patience to navigate long payer calls, transfers, and inconsistent information while capturing accurate details.
• Excellent organizational skills, attention to detail, and follow-through on time-sensitive and deadline-driven tasks.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficient in Google Workspace (Docs, Sheets, Calendar).

Preferred Qualifications

• Experience with Availity, CAQH, or other payer portals and enrollment systems.
• Experience in ABA therapy, behavioral health, or pediatric healthcare.
• Exposure to provider credentialing, payer enrollment, or licensing processes.
• Experience with EHR systems such as Passage Health.

Compensation: The hourly rate for this position varies by location: $24–$29/hour in Colorado and $21–$26/hour in New Mexico, depending on experience, qualifications, and location.