Licensing and Credentialing Manager

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $80k - $90k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Brightline

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Brightline is a healthcare company that specializes in providing mental health care services for children and support for parents. With a focus on personalized therapy, psychiatry, and medication management, Brightline offers a simple and comprehensive approach to mental health care for families. They serve clients both virtually and in-person, with services available in multiple states including New York, New Jersey, Connecticut, Massachusetts, and Washington. Through experienced providers and innovative care plans, Brightline helps children and their caregivers manage mental health challenges, focusing on Cognitive Behavioral Therapy and data-driven results.

📋 Description

• Own the CertifyOS vendor relationship, including budget accountability and renewal negotiations. • Direct the day-to-day work CertifyOS performs on Brightline's behalf and hold the vendor accountable to defined service levels. • Oversee all provider licensing and license renewals across multiple states. • Ensure timely submission, tracking, and renewal of provider licenses. • Monitor vendor performance against established service level agreements (SLAs). • Partner with internal stakeholders to ensure providers are licensed before scheduled start dates. • Identify opportunities to improve licensing workflows through automation and process optimization. • Maintain accurate licensing records and ensure compliance with all state licensing board requirements. • Manage all commercial, Medicaid, and managed Medicaid payer credentialing activities. • Personally oversee provider enrollment, re-credentialing, and payer applications from submission through approval. • Track credentialing status and proactively resolve enrollment delays. • Ensure providers are credentialed and billable prior to delivering patient care whenever possible. • Maintain complete and accurate credentialing documentation. • Monitor re-credentialing timelines to prevent credentialing lapses. • Own payer roster management across all contracted health plans. • Ensure provider roster submissions are accurate, timely, and synchronized with payer systems. • Coordinate provider additions, terminations, demographic updates, tax ID changes, and location updates with contracted payers. • Perform routine payer roster audits to identify and correct discrepancies. • Partner with Revenue Cycle teams to resolve billing issues resulting from roster inaccuracies. • Establish standardized processes for roster maintenance as the organization scales. • Develop and maintain strong relationships with commercial and government payer credentialing representatives. • Lead recurring monthly payer operational meetings focused on credentialing escalations, enrollment turnaround times, provider roster accuracy, re-credentialing performance, and process improvement opportunities. • Serve as the organization's primary escalation point for payer credentialing issues. • Represent the licensing and credentialing function in cross-functional forums with Contracting, Revenue Cycle, Compliance, Clinical Operations, and Legal, speaking for the function's priorities and status rather than simply coordinating within it. • Partner closely with those teams to resolve payer related issues impacting provider enrollment. • Support the development of delegated credentialing programs with contracted payers. • Collaborate with Compliance and Quality teams to ensure delegated credentialing requirements are met. • Coordinate payer audits and maintain audit readiness. • Own and report on the core metrics that define whether the function is working, including days to credential, license renewal on-time rate, and payer roster accuracy rate. • Define the processes, documentation, and workflows this function runs on today, built so they hold up as provider volume, state coverage, and payer relationships continue to scale. • Bring metric trends and process gaps to leadership proactively, rather than only when an issue has already caused a delay.

🎯 Requirements

• Bachelor's degree or equivalent combination of education and experience. • 5+ years of provider licensing and payer credentialing experience. • Strong understanding of CAQH, NPPES, PECOS, Medicare enrollment, Medicaid enrollment, and commercial payer credentialing. • Excellent communication, negotiation, and relationship management skills. • Strong problem-solving and escalation management abilities. • Ability to manage multiple priorities while maintaining exceptional attention to detail. • Experience leading cross-functional initiatives that improve operational performance. • Experience managing multi-state provider licensing. • Experience managing vendor relationships and delegated credentialing programs. • Experience working with CertifyOS or similar credentialing software preferred. • Preferred experience with: • Credentialing providers through commercial and Medicaid payers. • Managing payer roster submissions and provider directory accuracy.

🏖️ Benefits

• Medical, Dental, Vision, Long-Term Disability, Life Insurance, Flexible Spending Account, and 401k • 12 Company Holidays + Floating Holidays, Holiday Shutdown, Flexible Time Off, Parental Leave • Health and Wellness Stipend, Home Office Reimbursement and Professional Development Reimbursement • Stock Options