Theoria Medical Benefits Overview

Manage end-to-end provider enrollment and revalidation applications for commercial, Medicare, and Medicaid payers. Prepare and track submissions, maintain CAQH profiles and provider records, resolve payer deficiencies and rejections, monitor expirations, and ensure compliance with payer and regulatory requirements. The role also supports provider onboarding, coordinates with internal teams, communicates with payers, and improves enrollment processes for accuracy and timely completion.

Owns the company’s BI platform and data strategy across clinical, operations, finance, and HR functions. Responsibilities include setting the analytics product roadmap, governing data definitions and PHI, managing platform architecture, building dbt models and dashboards, delivering healthcare quality and value-based-care analytics, deploying conversational AI, coordinating vendors and multi-team programs, and developing an analytics team. The role requires hands-on ownership of clinical data, EHR integrations, semantic modeling, governance, and executive reporting.