Credentialing and Operations Manager

Plutonic; United States; Hybride; USD 48 000 - 83 000; Temps partiel

Résumé du poste

A technology-enabled mental health services company seeks a Credentialing & Operations Manager (Consultant) to oversee payer enrollment and insurance operations. The ideal candidate will possess strong experience in mental health credentialing and operational efficiency to enhance reimbursement processes. This hybrid part-time role requires in-person work as needed, prioritizing applicants with significant background in insurance operations and behavioral health billing.

Qualifications

• 3+ years of experience in behavioral health billing, credentialing, or revenue cycle management within the mental health industry.
• Strong understanding of CPT codes, telehealth rules, and payer requirements.
• Excellent communication, organization, and problem-solving skills.

Responsabilités

• Manage and submit therapist credentialing across various payers.
• Oversee collection of clinician documentation and licenses.
• Contribute to process improvements across operations.
• Serve as the primary point of contact with payer credentialing departments and networks.

Connaissances

Behavioral health operations

Revenue cycle management

Communication skills

Technical proficiency with EHR systems

Collaborative teamwork

Formation

Bachelor's degree in Healthcare Administration or related field

Bachelor’s degree in Public Health

Bachelor’s degree in Health Informatics

Bachelor’s degree in Business Administration

Bachelor’s degree in Psychology

Outils

TheraNest

SimplePractice

Athena

Description du poste

Overview

Plutonic | Technology-Enabled Mental Health Services

Plutonic is a technology-focused mental health services company pioneering immersive virtual therapy solutions for young people and families. We combine evidence-based care with modern digital tools to make therapy more accessible, engaging, and effective.

About the Role

Plutonic is seeking an experienced Credentialing & Operations Manager (Consultant) to lead payer enrollment, provider credentialing, insurance operations, and revenue optimization across our growing behavioral health organization.

This role is ideal for a consultant with deep experience in mental health credentialing, group contracting, Medicaid MCOs, and commercial payer operations, who can own and improve the systems that support reimbursement, compliance, and operational scale.

You will work closely with the CEO, clinical leadership, and internal teams to ensure our providers are properly credentialed, contracted under group plans, reimbursed accurately, and positioned for sustainable growth.

Responsibilities

Credentialing & Operations Management

• Manage and submit therapist credentialing across commercial, Medicaid, and Medicare payers (e.g., CAQH, NPPES, payer portals).
• Oversee collection and review of clinician documentation, licenses, degrees, and insurance requirements.
• Track enrollment statuses, maintain credentialing databases, and ensure timely renewals.
• Serve as the primary point of contact with payer credentialing departments and networks.

Revenue Cycle Management (RCM) & Insurance Operations

• Learn and support the full RCM process, including benefits verification, eligibility checks, authorization requirements, and reimbursement guidelines.
• Support claim preparation and submission, monitor claim statuses, and escalate denials or rejections for resolution.
• Help maintain payer records, fee schedules, and insurance updates relevant to behavioral health services.

Operational Efficiency & Platform Improvement

• Identify workflow bottlenecks and contribute to process improvements across client experience, billing, credentialing, and scheduling.
• Work directly with leadership to gather feedback from clients and therapists to improve both the platform and care operations.
• Collaborate cross-functionally with clinical, administrative, and technology teams to strengthen day-to-day operations.

Qualifications

• Bachelor’s degree in Healthcare Administration, Public Health, Health Informatics, Psychology, Business Administration, or a related field.
• Strong interest in behavioral health operations, digital health, revenue cycle management, or insurance processes.
• Excellent communication, organization, and problem-solving skills.
• Tech-savvy and comfortable navigating modern digital tools and EHR systems.
• Detail-oriented, analytical, and able to manage multiple priorities.
• Experience in healthcare operations, billing, customer experience, or administrative roles is a plus but not required.
• 3+ years of experience in behavioral health billing, credentialing, or revenue cycle management within the mental health industry (strongly preferred).
• Experience with commercial payers, Medicaid, and/or Medicare in a mental health or therapy practice.
• Strong understanding of CPT codes, telehealth rules, behavioral health reimbursement, and payer requirements.
• Proficiency with EHR systems and billing platforms (TheraNest, SimplePractice, Athena, or comparable).
• Highly organized, detail-oriented, and able to manage multiple deadlines.
• Strong communication skills and ability to collaborate with clinicians and operational leadership.
• Ability to analyze billing data, identify trends, and optimize workflows.
• Bachelor’s degree in Healthcare Administration, Health Information Management, Business, or related field preferred.

Location

Atlanta, Georgia United States

• This is a hybrid part-time contractor position with required in person work/meetings as needed.