Credentialing Manager

Finni Health • ,

21h • $70,000 - $85,000

About The Position

As a Credentialing Manager (Individual Contributor), you will play a critical role in optimizing our revenue cycle operations. Your primary responsibilities will include driving efforts to scale Finni's network of insurance contracts and unblock stalled applications with payers, ensuring efficient onboarding and ongoing relationship management. You will also oversee the enrollment submission team to ensure productivity expectations are met, active payer follow-up is timely, consistent, accurate, and recorded in the credentialing platform. Additionally, you will triage questions around payer enrollment updates, status, and general questions for providers and their respective support staff. Ensuring strict adherence to payer regulations, industry standards (e.g., CMS billing, NCQA Guidelines, Delegated Credentialing), and internal policies, maintaining high service and compliance standards across all RCM functions will be crucial. You will lead workflow optimization initiatives within RCM, manage specific projects, and drive continuous process improvements to maximize reimbursement and minimize denials. Collaboration with product, provider success, compliance, HR, finance, and other teams to align RCM efforts with overall business objectives and drive strategic goals is essential. You will also adapt and take on evolving responsibilities and projects as Finni Health grows and the RCM landscape changes.

Requirements

• 5+ years of relevant experience in credentialing or related roles, preferably in an early-stage startup, behavioral or mental health, or healthcare tech.
• Strong understanding of the payer credentialing processes, including core credentialing prerequisites, credentialing blockers and solutions to remediate, roster management, and demographic updates.
• Medicaid experience is required.
• Proven ability to work effectively within a team environment, contributing to collective success, and independently driving credentialing initiatives.
• Deep understanding of the full revenue cycle, including billing, claims processing, collections, accounts receivable management, payer contracting, and compliance (e.g., CMS billing).
• Strong ability to analyze complex RCM data, identify trends, root causes of issues, and implement effective, data-driven solutions to optimize financial performance.
• Demonstrated expertise in identifying inefficiencies and driving process improvements for RCM efficiency and effectiveness.
• Excellent written and verbal communication skills, with proven ability to effectively collaborate with internal teams and external stakeholders (payers, vendors, providers).
• Exceptional organizational and time management skills, with the ability to manage multiple priorities and projects in a fast-paced environment.
• Proficient in Google Suite, Slack, CRM/support software, and EHR/RCM management tools.
• Passion for Finni’s mission to democratize autism care and empower providers through robust RCM.
• Comfortable thriving in a dynamic, fast-paced startup environment, embracing change, and navigating ambiguity with a proactive mindset.

Nice To Haves

• Experience with various EMR/EHR work queue management within RCM is a plus.

Responsibilities

• Drive efforts to scale Finni's network of insurance contracts and unblock stalled applications with payers, ensuring efficient onboarding and ongoing relationship management.
• Oversee enrollment submission team to ensure productivity expectations are met, active payer follow-up is timely, consistent, accurate, and recorded in the credentialing platform.
• Triage questions around payer enrollment updates, status, and general questions for providers and their respective support staff.
• Ensure strict adherence to payer regulations, industry standards (e.g., CMS billing, NCQA Guidelines, Delegated Credentialing), and internal policies, maintaining high service and compliance standards across all RCM functions.
• Lead workflow optimization initiatives within RCM, manage specific projects, and drive continuous process improvements to maximize reimbursement and minimize denials.
• Collaborate extensively with product, provider success, compliance, HR, finance, and other teams to align RCM efforts with overall business objectives and drive strategic goals.
• Adapt and take on evolving responsibilities and projects as Finni Health grows and the RCM landscape changes.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed