Credentialing Manager
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Job Description
Credentialing Manager scaling payer networks and optimizing revenue-cycle operations for Finni Health's autism-care platform. Managing enrollment teams, compliance, and reimbursement improvement initiatives.
Responsibilities:
- Drive efforts to scale Finni Health's network of insurance contracts and unblock stalled payer applications
- Oversee the enrollment submission team and ensure timely, consistent, accurate payer follow-up recorded in the credentialing platform
- Triage provider and support-staff questions about payer enrollment updates and status
- Ensure adherence to payer regulations, CMS billing, NCQA Guidelines, Delegated Credentialing, and internal policies
- Lead RCM workflow optimization initiatives and manage projects to maximize reimbursement and minimize denials
- Collaborate with product, provider success, compliance, HR, finance, and other teams
- Take on evolving responsibilities and projects as Finni Health grows
Requirements:
- 5+ years of relevant experience in credentialing or related roles
- Experience in healthcare credentialing or provider enrollment
- Strong understanding of payer credentialing processes, including credentialing prerequisites, blockers and remediation, roster management, and demographic updates
- Medicaid experience is required
- Deep understanding of the full revenue cycle, including billing, claims processing, collections, accounts receivable management, payer contracting, and compliance
- Ability to analyze complex RCM data, identify trends and root causes, and implement data-driven solutions
- Expertise in identifying inefficiencies and driving RCM process improvements
- Excellent written and verbal communication skills
- Exceptional organizational and time management skills; ability to manage multiple priorities and projects
- Proficiency in Google Suite, Slack, CRM/support software, and EHR/RCM management tools
- Experience with EMR/EHR work queue management within RCM is a plus
- Ability to work collaboratively and independently in a dynamic, fast-paced startup environment
- Must be authorized to work in the United States
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