Credentialing/Payor Enrollment Specialist

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $60k - $64k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 20%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Brave Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

⚕️ Healthcare Insurance

📡 Telecommunications

💰 $40M Series C on 2022-10

Healthcare • Healthcare Insurance • Telecommunications

Brave Health is a company delivering comprehensive mental health care through telehealth solutions, focused on providing individualized therapy and psychiatric medication management. The company offers a wide array of services including individual therapy, marriage and family counseling, and clinician-led group therapy, and focuses on using evidence-based and specialized therapeutic programs such as Dialectical Behavior Therapy (DBT) and Eye Movement Desensitization and Reprocessing (EMDR). They are in-network with over 200 insurance plans, including commercial, Medicaid, and Medicare. Brave Health is committed to improving patients' access to care while reducing hospital readmissions, offering a personalized treatment approach through a diverse clinical team. Their programs emphasize the importance of data-driven and clinically proven strategies for mental health treatments.

📋 Description

• Manage the payor enrollment process in collaboration with the Director of Credentialing Operations. • Support clinical onboarding and ongoing enrollment, ensuring clinical providers are enrolled and renewed with health plans. • Compile and maintain current and accurate data for all clinical providers. • Manage credentialing documentation in databases and ensure timely enrollment and re-credentialing. • Perform primary source verification during initial credentialing and re-credentialing. • Maintain copies of enrollment forms, applications, and required documentation. • Maintain payor enrollment delegation rosters, including updates for new hires and former providers. • Partner with HR to ensure new providers are enrolled in health plans before their start date. • Assist new hires with Medicaid and Medicare applications, including reassigning Medicare benefits to Brave Health. • Address new-hire questions about payor enrollment and credentialing processes. • Ensure current credentialing documentation is submitted during onboarding for primary source verification. • Collaborate with vendors supporting payor enrollment processes. • Research new payor enrollment opportunities to enhance network participation. • Drive process and tool improvements as organizational needs evolve. • Identify efficiency opportunities, including outsourcing or new technology implementations.

🎯 Requirements

• Minimum of three years of relevant credentialing/payor enrollment experience required. • Strong knowledge of Medicaid, Medicare, and private payer insurance systems. • Highly organized with the ability to multitask and manage competing priorities effectively. • Skilled at working under pressure and adapting to the fast-paced, evolving needs of a startup environment. • Strong tools/automation orientation; proactive in seeking, evaluating, and recommending new technologies and tools to enhance scalability and efficiency. • NAMSS CPMSM or CPCS certification preferred. • Leadership experience in managing credentialing/payor enrollment teams or driving key process improvements preferred. • Associate’s or Bachelor’s degree in Healthcare, Business Administration, or a related field preferred. • Remote work experience strongly preferred. • Experience with Medicaid, Medicare, and commercial/private payers. • Experience with credentialing or payor enrollment platforms and databases such as CAQH, PECOS, NPPES, and state-specific Medicaid portals. • Experience collaborating with external vendors or partners to support credentialing or payor enrollment processes. • Experience in a healthcare startup, multi-state telehealth, or other fast-paced and rapidly growing healthcare environment. • At least one year of professional experience working in a fully remote role is requested in the application form.

🏖️ Benefits

• Comprehensive health, dental, and vision coverage. • Generous paid time off, including parental leave. • Fully remote, work from home position. • All equipment provided.