Sr. Manager, Credentialing Operations

The role

You will lead a team of twenty to manage the credentialing lifecycle and ensure providers are enrolled with payers. You will build processes, documentation, and controls to improve time to enrollment and data accuracy.

What you will do

• Hire, develop and set the performance bar across managers and coordinators
• Complete the reorganization of the function to a stage-based lifecycle model
• Own the time to enrolled metric and related data
• Reconcile system data to ensure reliable reporting
• Build controls and coverage to remove single points of failure
• Manage restricted-payer lists and enforce data-handling restrictions for offshore teams
• Build a per-payer requirements library and written procedures
• Manage backlog programs for enrollment records
• Manage payer relationships, revalidations, and roster management
• Partner with Product to translate team needs into engineering requirements

Required qualifications

• 5+ years in provider credentialing or payer enrollment, multi-state, across commercial payers and Medicaid or Medicaid managed care
• Medicaid experience is required
• Hands-on with CAQH, NPPES, PECOS, state Medicaid portals and commercial payer portals
• 2+ years managing and developing a team, ideally including leads or managers
• Experience changing how a team is structured
• Expertise in identifying inefficiencies and building fixes through SOPs, workflows, or SLAs
• Ability to work with operational data to identify trends and root causes
• Knowledge of delegated credentialing, NCQA standards, payer audits and data-handling restrictions
• Experience leading or working closely with offshore teams
• Excellent written and verbal communication
• Proficient in Google Suite, Slack, and credentialing platforms such as Verifiable, Medallion, Modio, Symplr or CAQH ProView

Nice to have

• Experience writing requirements for a product or engineering team

Benefits

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

About the company

Finni Health empowers autism care providers to start, run, and grow their own practices. They provide access to an insurance network, EHR software, HR solutions, and clinical support.