Director, Payer Enrollment

About Medallion:
At Medallion, we believe healthcare teams should focus on what truly matters—delivering exceptional patient care. That’s why we’ve built a leading provider operations platform to eliminate the administrative bottlenecks that slow healthcare organizations down. By automating licensing, credentialing, payer enrollment, and compliance monitoring, Medallion empowers healthcare operations teams to streamline their workflows, improve provider satisfaction, and accelerate revenue generation, all while ensuring superior patient outcomes.

As one of the fastest-growing healthcare technology companies—ranked No. 3 on Inc. Magazine’s 2024 Fastest-Growing Private Companies in the Pacific Region, No. 5 on LinkedIn's 2024 Top Startups in the US, a Glassdoor Best Place to Work in 2024 & 2025, and featured on The Today Show—Medallion is revolutionizing provider network management. Our CEO, Derek Lo, has been named one of the Top 50 Healthcare Technology CEOs of 2024 by The Healthcare Technology Report. Backed by $130M in funding from world-class investors like Sequoia Capital, Google Ventures, Optum Ventures, Salesforce Ventures, Acrew Capital, Washington Harbour, and NFDG, we’re on a mission to transform healthcare at scale.

We prioritize candidate safety. Please be aware that official communication will only come from @medallion.co email addresses.

About the Role:

As Medallion’s Director of Payer Enrollment, you will play a crucial role in the leadership of our Payer Enrollment team. Our PE Team is core to our business and is responsible for making sure payer enrollment execution runs smoothly. You are succeeding in this role when the PE team is: scaling efficiently, making high quality, data-driven decisions, and embracing a culture of continuous process improvement. 

We’re looking for someone who has the ability to act tactically as well as strategically, possesses extensive work experience related to task-based workflows and quality metrics (KPI’s), as well as a demonstrated ability to drive results across a variety of workstreams. The ideal candidate is extremely comfortable conducting ongoing performance analysis and is able to identify meaningful opportunities with both internal and external stakeholders and define and implement subsequent action plans.

The role will report directly to the Senior Director of Operations and base compensation may land between $130,000-$180,000. In addition to base salary, Medallion offers equity, and benefits as part of the total compensation package. Many factors are considered when determining pay including: market data, geographic location, skills, qualifications, experience, and level.

Responsibilities:

• Develop and manage Payer Enrollment leaders at various levels of professional tenure. Help your direct reports grow their skills via mentorship, 1:1s, and reviews
• Support measuring and planning for the team’s performance, capacity, and growth targets
• Implement new, as well as optimize existing, tools, processes, systems, and products that streamline the Payor Enrollment team’s work and increase their efficiency/accuracy (i.e standardized playbooks, communication templates, training materials, resource guides, automation features, advanced tooling, etc.)
• Works with both internal and external stakeholders to resolve complex provider enrollment issues as they arise
• Owning, measuring, and providing insights on renewal forecasts, customer health, customer surveys, and product usage.
• Serve as the primary point of contact for customer-facing issues related to overall performance and/or quality to effectively resolve escalations.
• Manage and improve the systems that help support the team’s processes. Current systems include Medallion proprietary and public ones (e.g. Front, GSheets, Salesforce)
• Design and conduct training regarding provider enrollment process and systems/process improvement initiatives
• Constantly learn about industry best practices and bring new ideas to the organization about how to drive efficiency, growth and customer outcomes
• Direct ownership over Medallion’s PE function to consistently drive operational excellence and cost efficiency.
• Certifications: Consider requiring or preferring certifications such as CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management).
  Industry Network: Established relationships with payer representatives and industry associations.
• Crisis Management: Experience managing large-scale disruptions (payer policy changes) with resilience and minimal customer impact.

Qualifications:

• Experience:
• • 10+ years of experience in payer enrollment, with a focus on enrolling providers with multiple payers, including commercial, Medicaid, and Medicare.
  • Proven ability to manage high-volume enrollments (5,000+ enrollments monthly) across multiple payers.
  • Experience in working with healthcare providers and understanding of credentialing processes.
• Leadership Skills: 
• • Minimum of 5 years in a leadership role, managing payer enrollment teams or related operational functions.
  • Strong ability to lead, motivate, and manage a team in a fast-paced, dynamic environment.
• Technical Skills:
• • Proficiency with enrollment and credentialing software tools (e.g., CAQH, PECOS, Availity, or other payer portals).
  • Familiarity with workflow automation tools and software to streamline payer enrollment processes.
  • Strong data analysis skills to assess enrollment trends and performance metrics.
  • Knowledge:
• Knowledge:
• • Thorough understanding of payer enrollment processes, payer contracts, regulatory requirements, and compliance in the healthcare industry.
  • In-depth knowledge of healthcare payer systems, including Medicaid, Medicare, commercial insurance plans, and third-party administrators.
• Desired Skills & Competencies:
• • Strong problem-solving and decision-making skills, especially when dealing with complex payer enrollment challenges.
  • Excellent communication skills, with the ability to liaise between providers, internal teams, and external payers effectively.
  • Ability to multitask, prioritize, and manage large-scale projects with tight deadlines.
  • Strong organizational and project management skills to handle high-volume enrollments.
  • Detail-oriented and committed to maintaining compliance with regulatory standards and payer requirements.