Senior Manager, Credentialing Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the credentialing operations function that determines the speed at which Finni practices can start seeing clients and receiving payments.

• Manage a team of four Credentialing Managers and sixteen coordinators and associates operating across various time zones.

• Recruit, mentor, and establish performance benchmarks for managers and coordinators.

• Facilitate the transition from practice-group-aligned managers to ownership of the stage-based credentialing lifecycle.

• Take responsibility for Time to Enrolled, blocked billing by cause, clean submission rate, and compliance with aging and follow-up.

• Reconcile discrepancies in enrollment status data across systems and ensure reliable reporting.

• Develop controls, cross-training initiatives, segregation of duties, and coverage plans to eliminate single points of failure.

• Manage restricted-payer lists and enforce data-handling restrictions concerning payers and state Medicaid programs.

• Create libraries of per-payer requirements and develop written procedures specific to states and payers.

• Define and execute backlog programs addressing missing participation proof, departed providers, and absent approval dates.

• Oversee provider-level revalidations, roster management, directory accuracy, and demographic updates.

• Assess risks and provide recommendations regarding options such as provisional credentialing.

• Act as the credentialing representative in Product, translating operational needs into engineering requirements and validating delivered solutions.

• Collaborate with Practice Success, revenue cycle, payer contracting, HR, and compliance teams.

• Adjust to changing responsibilities as Finni Health expands and regulations evolve.

⛳️ Requirements

• A minimum of 5 years of experience in provider credentialing or payer enrollment.

• Experience across multiple states with commercial payers as well as Medicaid or Medicaid managed care.

• Medicaid experience is essential.

• Hands-on experience with CAQH, NPPES, PECOS, state Medicaid portals, and commercial payer portals.

• Proven track record of submitting applications directly and resolving enrollment delays.

• At least 2 years of experience in managing and developing a team.

• Background in restructuring teams and altering work distribution.

• Demonstrated ability to identify inefficiencies and implement process enhancements.

• Strong capability to analyze operational data, discern trends and root causes, and execute data-driven solutions.

• Understanding of delegated credentialing, NCQA standards, payer audits, and data-handling restrictions.

• Experience in leading or collaborating closely with offshore teams.

• Excellent written and verbal communication abilities.

• Proficiency in Google Suite, Slack, and credentialing platforms such as Verifiable, Medallion, Modio, Symplr, or CAQH ProView.

• Experience in drafting requirements for a product or engineering team is advantageous.

• A strong commitment to Finni's mission of democratizing autism care.

• Comfort in a dynamic, fast-paced startup environment and the ability to navigate ambiguity.

🏝️ Benefits

• 401(k)

• Health insurance

• Dental insurance

• Vision insurance

• Flexible schedule

• Paid time off

• Paid Holidays