Payer Operations Manager (EDI, EFT & Portal Management)

Compensation:
LATAM: $2000$3000 USD/month
South Africa: $2200$3500 USD/month
Philippines: $1500$2300 USD/month

Exceptional candidates with deep U.S. payer connectivity and enrollment expertise may be considered above range.

Employment Type: Full-Time Independent Contractor
Location: Remote
Working Hours: U.S. Business Hours Overlap Required

Our client is a growing healthcare technology and financial services company focused on improving the infrastructure and operational workflows that support healthcare organizations.

As the company scales accurate payer connectivity provider information electronic transactions and payment enrollment are critical to keeping financial workflows running smoothly.

We are seeking an experienced Payer Operations Manager with hands-on expertise in U.S. healthcare payer enrollment EDI/EFT setup and provider and payer data management.

This is a specialized operational role for someone who understands the practical realities of working with U.S. insurance payers clearinghouses and healthcare portals.

You will own payer-related operational workflows ensuring that provider and payer information is accurate enrollments move forward electronic transactions are properly established and issues are followed through to resolution.

The ideal candidate is highly detail-oriented persistent and comfortable navigating multiple payer systems and portals.

• Manage end-to-end payer enrollment and connectivity workflows
• Coordinate EDI EFT and ERA enrollments with commercial and government payers
• Track enrollment status requirements approvals rejections and outstanding actions
• Coordinate with clearinghouses and payer representatives to resolve enrollment and connectivity issues
• Follow up consistently on delayed or incomplete enrollments
• Help ensure electronic claims and payment workflows are properly established

• Maintain accurate provider information across payer systems and portals
• Manage provider demographic information including:
  • Billing addresses
  • Service addresses
  • NPI
  • TIN
  • W-9 information
  • Related provider data
• Maintain and monitor access to payer and healthcare portals
• Coordinate provider information updates attestations roster changes and other ongoing payer maintenance
• Identify discrepancies between provider information across systems and drive them through resolution
• Maintain accurate records of payer requirements and enrollment status

• Identify repetitive or inefficient payer workflows
• Document payer-specific requirements processes and recurring issues
• Develop and maintain SOPs and operational documentation
• Partner with operations and technology teams to improve payer-related workflows
• Help identify opportunities to automate manual enrollment data-management and connectivity processes
• Translate operational requirements into clear processes that can be supported by technology

• 4 years of hands-on experience in U.S. healthcare payer operations payer enrollment credentialing healthcare administration or payer connectivity
• Direct experience with EDI and/or EFT/ERA enrollment processes
• Strong familiarity with U.S. commercial and government payers
• Experience working with healthcare payer portals and clearinghouses
• Working knowledge of healthcare EDI transactions particularly /271 and/or 276/277
• Experience maintaining provider demographic and payer information
• Strong understanding of NPI TIN W-9 provider enrollment and related healthcare data
• Experience troubleshooting payer enrollment or connectivity issues
• Strong attention to detail and data accuracy
• Comfortable working across multiple healthcare systems and web-based platforms

• Exceptionally detail-oriented
• Highly organized and process-driven
• Persistent with strong follow-through
• Comfortable working independently
• Strong written and spoken English
• Strong problem-solving skills
• Able to manage multiple payer workflows simultaneously
• Comfortable communicating with payer representatives internal stakeholders and technical teams
• Naturally curious about systems and process improvement

The strongest candidate will have deep practical experience navigating the U.S. payer ecosystem.

They should understand how payer enrollment actually works be comfortable working through EDI/EFT/ERA processes and know how to resolve issues across payer portals clearinghouses providers and internal teams.

This is not a general operations manager role. We are specifically looking for someone with meaningful hands-on experience in payer operations enrollment and connectivity.

Payer connectivity and accurate provider information sit underneath many healthcare financial and operational workflows.

The right person will help ensure these foundational processes are accurate controlled properly maintained and increasingly scalable as the company grows.

Required Experience:

Manager