Brightside Health

Manager

• Leverage your experience in behavioral health provider credentialing to develop, manage and monitor processes, policies and procedures that support the credentialing and re-credentialing processes of providers.
• Interface with CAQH, insurance company credentialing leaders, provider services, human resources and operations to ensure a smooth credentialing process including, but not limited to: CVO performance monitoring
• Managing report generation
• Provider communication (as needed)
• Committee set-up and provider credentials approval process and tracking
• Delegation audit coordination
• Primary source verification (PSV) tracking
• Communication with payers regarding delegated credentialing requirements
• Oversee the payer enrollment stage with health plans. Experience interacting with health plan counterparts and familiarization with the health plan landscape is a requirement.
• Oversee all aspects of the Credentialing Review Committee, including scheduling meetings, ensure documentation preparation, meeting notes, etc in partnership with the CVO.
• Prepare Brightside to be a delegated credentialing entity through the development of policies and procedures.
• Prepare for and coordinate credentialing audits in compliance with managed care credentialing contracts.
• Coordinate with clinical operations and onboarding as it relates to credentialing, re-credentialing and provider access.

Senior Manager, Credentialing and Enrollment

Billing Specialist

• Collaborate with product, engineering, and operations on an ongoing basis to ensure that the Brightside system correctly completes eligibility verification and claim submission
• Monitor all claims to ensure clean submission and timely payment
• Report payor and denial trends to Billing Manager in timely manner
• Accurately document patient accounts to reflect all actions taken, or status of follow up, in billing system
• Assist in error resolution, resubmits insurance claims that have received no response or are not on file
• Follow up on denials and/or unpaid or improperly paid claims
• Post payments timely on the database, update account statements, generate financial reports, release invoices, and resolve account discrepancies
• Review and monitors select accounts within the accounts receivable system, determines and performs appropriate collection actions to resolve accounts
• Participate in problem solving, formulating solutions and implementing them into daily processes

Operations

• Bulk actioning claims and performing root-cause analysis on high-volume denials, rejections, and delays.
• Analyzing billing and claims data to identify trends, systemic issues, and opportunities for process improvement.
• Leveraging our external billing system to resolve priority issues quickly and optimize software capabilities.
• Building, refining, and documenting billing and RCM SOPs to standardize workflows and reduce preventable rework, and increase efficiency.
• Collaborating with the Director of RCM to prioritize the highest-impact billing and claims work.
• Utilizing system tools and functionality to streamline claim submission, follow-up, and resolution processes.
• Offering guidance on best practices and recommending process changes to improve billing efficiency and outcomes.
• Continuously identifying ways to streamline billing operations and maximize revenue capture.
• Developing and leading claims projects, leveraging team resources and providing training to team members to support ongoing claims work.
• Supporting ad hoc initiatives such as new service line launches, contract changes, or system enhancements — secondary to the primary focus of billing and claims execution.

RCM Operations Associate

Network Operations

• Support the development and execution of network growth strategies across all care service lines to ensure adequate access, efficient utilization, and scalability.
• Use data to drive insights around provider capacity, performance, network gaps, and patient demand trends.
• Collaborate cross-functionally with Network Operations, Clinical Strategy, Product, and Commercial teams to identify high-impact opportunities for expansion and optimization.
• Build and maintain strategic frameworks and models to guide decision-making on network expansion, configuration, and resourcing.
• Contribute to provider compensation strategy development and optimization, aligning incentives with clinical quality and operational efficiency.
• Contribute to network quality improvement initiatives by surfacing inefficiencies, tracking performance metrics, and recommending structural improvements.
• Partner with Product stakeholders to operationalize network strategies through tools, workflows, and system enhancements.
• Assist in special projects focused on network transformation, care model innovation, or payer readiness.

Network Operations Manager

Customer Support

• Cover phone, email, and chat support
• Escalate and/or triage issues as needed
• Display active listening and patience to all existing and potential customers
• Interact effectively with various teams to provide assistance and information
• Solve routine and complex issues; escalating issues to the appropriate teams
• Perform additional duties as required

Senior Manager, Credentialing and Enrollment

Billing Specialist

RCM Operations Associate

Network Operations Manager

Care Support Representative