Payer Relations and Credentialing Specialist

 

Curis Functional Health is a rapidly growing healthcare organization dedicated to transforming patient care through a multidisciplinary functional healthcare model. Our clinics offer integrated services including chiropractic, mental health, nutrition, and women’s health to deliver comprehensive, whole-person care. With over 50 clinics across multiple states, we are committed to quality, innovation, and exceptional patient experiences. Recognized among the Top 50 Fastest Growing Companies in the area, we seek a skilled Payer Relations & Credentialing Specialist to support our payer relations, provider credentialing, contracting, enrollment, and reimbursement efforts. This role involves managing the entire credentialing lifecycle and fostering strong relationships with commercial and government payers to facilitate organizational growth.

Responsibilities: Manage payer relations, contracting, credentialing, and enrollment activities across the organization to ensure seamless payer participation and provider access. Develop and maintain strong relationships with national and regional payers such as BCBS, UnitedHealthcare, Aetna, Cigna, and Medicare. Support expansion into new markets by identifying payer participation opportunities and optimizing reimbursement strategies through fee schedule reviews and contract negotiations. Monitor payer policies, reimbursement trends, and market developments to inform organizational decisions.

Oversee the full provider credentialing process, including application submission, recredentialing, and ongoing credential maintenance across multiple states. Ensure timely completion of provider applications and accurate documentation within payer systems like CAQH. Track enrollment statuses, deadlines, and recredentialing requirements while maintaining detailed records. Collaborate with providers and internal teams to resolve credentialing issues proactively.

Develop and implement policies, workflows, procedures, and performance metrics to improve credentialing efficiency. Maintain compliance with multi-state requirements and regulatory standards while supporting delegated credentialing initiatives. Contribute to process improvements that reduce turnaround times and operational risks.

Support new clinic openings and market expansion efforts by ensuring payer participation readiness. Partner with leadership on payer strategy development and credentialing compliance initiatives. Collaborate cross-functionally with providers, operations, revenue cycle teams, and compliance staff to ensure smooth payer engagement. Provide insights into credentialing performance metrics and market trends to facilitate organizational growth.

Qualifications: Minimum of 5 years of experience in provider credentialing, payer enrollment, healthcare contracting, or related revenue cycle functions within healthcare organizations or delegated environments. Prior experience working directly with commercial payers such as BCBS, UnitedHealthcare, Aetna, Cigna, or Medicare is preferred. Strong understanding of provider credentialing processes, reimbursement methodologies, multi-state payer requirements, and systems like CAQH is essential.

Excellent interpersonal skills with the ability to build professional relationships with payers, providers, leadership teams, and internal stakeholders. Strong written and verbal communication skills are required. Demonstrated organizational abilities with attention to detail are crucial for managing multiple projects simultaneously. Analytical skills for evaluating reimbursement trends and market data are necessary.

Ability to work independently in a fast-paced environment while collaborating effectively within a team is vital. Experience supporting growth initiatives in expanding healthcare organizations is a plus. This position is in person! 

Why Join Curis Functional Health? At Curis Functional Health, you will have the opportunity to influence the growth of a dynamic healthcare organization dedicated to innovative patient care. Your contributions will ensure our providers are properly credentialed and connected with the right payer networks so patients can access comprehensive services. Join a supportive team that values quality improvement, collaboration, professional development, and making a meaningful impact on whole-person healthcare.

Benefits: Health insurance

Paid time off

Referral program

Opportunities for professional growth within a rapidly expanding organization

Equal Employment Opportunity: Curis Functional Health is an equal opportunity employer committed to diversity in the workplace. We prohibit discrimination based on race, color, religion, age, sex (including gender identity), national origin or ancestry, disability status or genetic information; protected veteran status; or any other legally protected characteristic.