Babylist · 7 hours ago
Payer Operations Specialist
United States
Full-time
Remote
Mid, Senior Level
$85K/yr - $102K/yr
3+ years expBabylist is the leading registry and e-commerce platform for growing families, and they are seeking a Payer Operations Specialist to manage payer contracting across Medicaid and commercial payers. This role focuses on ensuring that contracts and credentials are submitted accurately and maintained, while also supporting the operational readiness and compliance of payer contracts.
BabyE-CommerceHealth CareInternetMarketplaceParentingToys
Responsibilities
Maintain detailed documentation and renewal schedules for licenses, credentials, and payer requirements
Own requirements for and execution of site inspections across multiple office locations
Coordinate responses to payer and regulatory requests for information in the event of an audit or otherwise
Own the end-to-end payer onboarding process, ensuring payers are fully loaded prior to effective dates
Partner with Billing and Ops teams to ensure claims and billing workflows are configured correctly, EFT and remittance are set up, authorization and denial management processes are in place, and reimbursement rates are clearly articulated
Act as the operational point of contact during payer go-lives
Maintain ongoing compliance and good standing across 85+ payer contracts
Support contract amendments, renewals, and updates
Track payer performance indicators such as rejections/denials, AR aging, patient responsibility, and cancellation rates, escalating issues as needed
Work closely with Payer Leads, Legal, Finance, Billing, Ops, and CS teams
Ensure payer requirements are clearly documented and communicated internally
Support rate change implementations and contract conversions from third-party to direct relationships
Qualification
Required
You have 3–6+ years of experience in payer operations, credentialing, or healthcare contracting
You're highly detail-oriented with strong project management skills and can manage multiple payer uploads and deadlines simultaneously
You have strong cross-functional communication skills and can translate complex payer requirements for non-expert audiences
You're scrappy and resourceful—when a payer contact goes radio silent, you find creative ways to get the information you need
You thrive in startup environments where you can build processes from scratch and aren't afraid of ambiguity
You're comfortable and enthusiastic about working in an AI-forward environment where AI tools are part of daily operations
You embrace using technology to enhance your work while keeping people at the center
Preferred
You have experience across both Medicaid and commercial payers (strongly preferred)
Benefits
Company-paid medical, dental, and vision insurance
Retirement savings plan with company matching and flexible spending accounts
Generous paid parental leave and PTO
Remote work stipend to set up your office
Perks for physical, mental, and emotional health, parenting, childcare, and financial planning
Company
Babylist
Babylist is an online platform that offers baby registry for expecting parents and products such as toys, baby care, and clothing.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
$40.65MKey Investors
Norwest
2021-11-04Series C· $40M
2018-02-15Series Unknown
2013-06-25Seed· $0.65M
Leadership Team
Natalie Gordon
CEO & Founder
Recent News
EIN Presswire
2025-09-30
Company data provided by crunchbase