Credentialing/Payor Enrollment Specialist

In this crucial role, you will manage the payor enrollment process, working closely with our Director of Credentialing Operations. You'll be a key contributor to our clinical onboarding and ongoing enrollment, ensuring that all clinical providers are efficiently enrolled and renewed with health plans. We’re seeking someone who thrives in a fast-paced environment, has an eye for process improvement, and is eager to explore innovative solutions—whether it's enhancing efficiency or leveraging new tools. The ideal candidate should be passionate about healthcare access.

Provider Data Management & Credentialing:

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  Compile and maintain current and accurate data for all clinical providers.

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  Manage credentialing documentation within databases, ensuring timely enrollment and re-credentialing.

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  Perform primary source verification during initial credentialing and re-credentialing.

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  Maintain copies of enrollment forms, applications, and other required documentation.

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  Oversee and maintain payor enrollment delegation rosters, including updates for new hires and providers no longer employed by Brave Health.

Onboarding & Payor Enrollment:

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  Partner with HR to ensure new providers are fully enrolled in health plans before their start date.

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  Assist new hires with Medicaid and Medicare applications, including reassigning Medicare benefits to Brave Health.

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  Serve as a resource for new hires, addressing questions related to payor enrollment and credentialing processes.

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  Ensure the submission of current credentialing documentation during onboarding for primary source verification.

Process Improvement & Vendor Management:

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  Collaborate with vendors to support payor enrollment processes.

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  Research new payor enrollment opportunities to enhance network participation.

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  Drive process and tool improvements, adapting to the growth and evolving needs of the organization.

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  Identify areas for increased efficiency, including potential outsourcing or new technology implementations to streamline operations.

• 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.

• Certification by the National Association of Medical Staff Services (NAMSS) as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) is preferred.

• Preference for candidates with 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 is preferred.

• Remote work experience is strongly preferred.