Revenue Cycle Claims Specialist
Finni Health (YC W23)
Job Level
Mid-LevelSenior
About the role
- Lead the Credentialing Team
- Provide day-to-day leadership and coaching to the credentialing team, supporting workload prioritization, development, and performance
- Monitor individual and team output to ensure credentialing tasks are completed accurately and on schedule
- Create clarity on priorities, foster shared accountability, and help your team take pride in delivering high-quality work
- Credentialing Operations
- Oversee the end-to-end credentialing and re-credentialing process for all PMHNPs, ensuring compliance with all state, payer, and accreditation requirements
- Ensure credentialing operations are efficient, timely, and scalable to support Lavender’s national expansion
- Partner with Billing to align credentialing with payer enrollment and avoid delays in reimbursement
- Collaborate with Recruiting and Onboarding teams to ensure clinicians are credentialed in advance of seeing clients
- Work with Marketing to communicate new payer partnerships internally and externally
- Review and maintain payer contracts and reimbursement rates, negotiating favorable terms where appropriate
- Credentialing Strategy & Growth
- Continuously assess credentialing systems and workflows to improve quality, efficiency, and compliance
- Evaluate new payer networks and credentialing opportunities to expand access to care
- Build and leverage strong payer relationships to improve reimbursement rates and streamline enrollment
- Support strategic growth initiatives by ensuring credentialing is prepared to support expansion into new states or services
- What Success Looks Like
- Credentialing files are accurate, compliant, and submitted on schedule
- New NPs are fully credentialed and able to see clients on time
- Payer enrollments are completed efficiently, minimizing revenue delays
- New payer relationships are established with favorable reimbursement rates
- Stakeholders across Billing, Recruiting, and Leadership feel supported and informed
- Geographic expansions are anticipated and executed smoothly from a credentialing perspective
Requirements
- 5+ years of experience in healthcare credentialing, including 3+ years in a leadership role
- Deep understanding of commercial, Medicare, and Medicaid credentialing requirements
- Experience credentialing providers across multiple U.S. states, preferably advanced practice providers
- Familiarity with payer enrolment processes and how credentialing ties into billing workflows
- Experience negotiating payer contracts and reimbursement rates
- Prior involvement in building or managing delegated credentialing programs (preferred)
- Strong knowledge of NCQA, CMS, and other regulatory and compliance standards
- Ability to design efficient processes, manage a high-performing team, and identify opportunities for improvement
- Excellent written and verbal communication skills, including the ability to collaborate across functions and serve as a key point of contact
- Detail-oriented, solution-focused, and self-motivated with a passion for driving impact
