Senior Manager, Credentialing and Enrollment
Brightside Health
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Senior
About the role
- 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.
Requirements
- Depth of experience in Credentialing Leadership
- Start-up experience is highly valued
- Excellent communication skills, both written and verbal
- Deep and experienced knowledge of delegated credentialing
- Creative problem-solver, flexible thinking, and ability to meet deadlines with accuracy in work
- Highly organized and detail-oriented
- Experience leading a credentialing team and excellent people management skills
Benefits
- Fully paid for comprehensive health care (medical, dental, vision)
- Pet Insurance
- Life Insurance & Short / Long Term Disability
- 401k Plan
- Unlimited PTO and sick leave
- Parental Leave
- Work remotely and whatever schedule works best for you
- Additional memberships and perks
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
credentialingre-credentialingprimary source verificationreport generationdelegated credentialingcredentialing auditscredentialing policiescredentialing proceduresCVO performance monitoringprovider access
Soft skills
communication skillspeople managementproblem-solvingflexible thinkingorganizational skillsdetail-orienteddeadline managementleadershipteam managementcreativity