Credentialing/Payor Enrollment Specialist

The role

You will manage the payor enrollment process and clinical onboarding. You will work with the Director of Credentialing Operations to ensure providers are enrolled and renewed with health plans.

What you will do

• Compile and maintain current and accurate data for all clinical providers.
• Manage credentialing documentation within databases.
• Perform primary source verification during initial credentialing and re-credentialing.
• Maintain copies of enrollment forms, applications, and other required documentation.
• Oversee and maintain payor enrollment delegation rosters.
• Partner with HR to ensure new providers are fully enrolled in health plans before their start date.
• Assist new hires with Medicaid and Medicare applications.
• Serve as a resource for new hires regarding payor enrollment and credentialing processes.
• Collaborate with vendors to support payor enrollment processes.
• Research new payor enrollment opportunities and drive process and tool improvements.

Required qualifications

• 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.

Nice to have

• Certification by the National Association of Medical Staff Services (NAMSS) as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS)
• Leadership experience in managing credentialing/payor enrollment teams or driving key process improvements
• Associate’s or Bachelor’s degree in Healthcare, Business Administration, or a related field
• Remote work experience

Benefits

• Comprehensive health, dental, and vision coverage.
• Generous paid time off, including parental leave.
• All equipment provided!

About the company

Brave Health is a community health-centered organization dedicated to expanding access to compassionate, high-quality mental health care through technology.