Senior Manager, Credentialing Operations

🔥 6 minutes ago

🇺🇸 United States – Remote

💵 $115k - $140k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 Ghost score 5%

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Finni Health (YC W23)

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2022

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance • Mental Health

Finni Health is a nationwide provider of expert ABA (Applied Behavior Analysis) and mental health care designed for families navigating autism. By connecting families with highly qualified therapists, Finni offers personalized support that includes in-home or in-clinic services, flexible scheduling, and family-led goal setting. With a commitment to results-based care, Finni is dedicated to improving the lives of children with autism and their families through dedicated therapy that enhances daily living skills, communication, and emotional regulation.

📋 Description

• Lead the credentialing operations function that determines how quickly Finni practices can begin seeing clients and getting paid • Lead a team of four Credentialing Managers and sixteen coordinators and associates working across time zones • Hire, develop and set performance standards across managers and coordinators • Complete the transition from practice-group-aligned managers to stage-based credentialing lifecycle ownership • Own Time to Enrolled, blocked billing by cause, clean submission rate, and aging and follow-up compliance • Reconcile conflicting enrollment status data across systems and maintain trusted reporting • Build controls, cross-training, segregation of duties and coverage plans to remove single points of failure • Own restricted-payer lists and enforce data-handling restrictions for payers and state Medicaid programs • Build per-payer requirements libraries and state- and payer-specific written procedures • Scope and complete backlog programs involving missing participation proof, departed providers and missing approval dates • Manage provider-level revalidations, roster management, directory accuracy and demographic updates • Evaluate risks and make recommendations regarding options such as provisional credentialing • Represent credentialing in Product, translate operational needs into engineering requirements, and verify delivered solutions • Collaborate with Practice Success, revenue cycle, payer contracting, HR and compliance • Adapt to evolving responsibilities as Finni Health grows and regulations change

🎯 Requirements

• 5+ years in provider credentialing or payer enrollment • Multi-state experience across commercial payers and Medicaid or Medicaid managed care • Medicaid experience required • Hands-on experience with CAQH, NPPES, PECOS, state Medicaid portals and commercial payer portals • Experience submitting applications directly and resolving enrollment delays • 2+ years managing and developing a team • Experience restructuring a team and changing how work is divided • Demonstrated expertise identifying inefficiencies and building process improvements • Strong ability to work with operational data, identify trends and root causes, and implement data-driven solutions • Familiarity with delegated credentialing, NCQA standards, payer audits and data-handling restrictions • Experience leading or working closely with offshore teams • Excellent written and verbal communication skills • Proficiency in Google Suite, Slack, and credentialing platforms such as Verifiable, Medallion, Modio, Symplr or CAQH ProView • Experience writing requirements for a product or engineering team is a plus • Passion for Finni's mission to democratize autism care • Comfortable working in a dynamic, fast-paced startup environment and navigating ambiguity

🏖️ Benefits

• 401(k) • Health insurance • Dental insurance • Vision insurance • Flexible schedule • Paid time off • Paid Holidays

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