Credentialing/Payor Enrollment Specialist

Brave Health

2d•$60,000 - $64,000•Remote

About The Position

Brave Health is seeking a Credentialing/Payor Enrollment Specialist to manage payor enrollment and support clinical onboarding and ongoing enrollment. The specialist will work closely with the Director of Credentialing Operations to ensure clinical providers are efficiently enrolled and renewed with health plans. The role suits someone who can work in a fast-paced environment, improve processes, and explore tools that increase efficiency, with a commitment to expanding access to healthcare.

Requirements

At least three years of relevant credentialing or payor enrollment experience.
Strong knowledge of Medicaid, Medicare, and private payer insurance systems.
Strong organizational skills and ability to multitask and manage competing priorities.
Ability to work under pressure and adapt to a fast-paced, evolving startup environment.
Proactive approach to evaluating and recommending technologies and tools to improve scalability and efficiency.

Nice To Haves

NAMSS certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS).
Leadership experience managing credentialing or payor enrollment teams, or driving key process improvements.
Associate’s or Bachelor’s degree in Healthcare, Business Administration, or a related field.
Remote work experience.

Responsibilities

Compile and maintain current, accurate data for clinical providers.
Manage credentialing documentation in databases and ensure timely enrollment and re-credentialing.
Perform primary source verification during initial credentialing and re-credentialing.
Maintain copies of enrollment forms, applications, and other required documentation.
Maintain payor enrollment delegation rosters, including updates for new hires and providers who are no longer employed by Brave Health.
Partner with HR to ensure new providers are fully enrolled in health plans before their start date.
Assist new hires with Medicaid and Medicare applications, including reassigning Medicare benefits to Brave Health.
Answer new hires’ questions about payor enrollment and credentialing processes.
Ensure current credentialing documentation is submitted during onboarding for primary source verification.
Collaborate with vendors to support payor enrollment processes.
Research new payor enrollment opportunities to enhance network participation.
Improve processes and tools in response to organizational growth and changing needs.
Identify opportunities to increase efficiency, including outsourcing or implementing new technology.