Credentialing/Payor Enrollment Specialist

Health Data Innovations, Inc.; Florida; Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health, dental, and vision coverage

Generous paid time off including paren

Fully remote, equipment provided

Job summary

Brave Health is seeking a skilled professional to manage provider credentialing and payor enrollment, ensuring timely enrollment and renewals across Medicaid, Medicare, and private plans. You will work closely with the Director of Credentialing Operations to support onboarding and ongoing enrollment, driving efficiency in a fast-paced startup environment.

Strong organizational skills and experience with credentialing systems are required, with remote work flexibility and a focus on expanding

Qualifications

• Minimum of three years of credentialing/payor enrollment experience.
• Strong knowledge of Medicaid, Medicare, and private payer insurance systems.
• Highly organized with the ability to multitask in a fast-paced environment.
• Startup experience and initiative to drive process improvements.

Responsibilities

• Manage payor enrollment and credentialing for clinical providers.
• Perform primary source verification during initial credentialing and re-credentialing.
• Maintain enrollment documentation and onboarding materials.
• Collaborate with HR and vendors to ensure timely enrollment and renewals.

Skills

Credentialing/payor enrollment

Medicaid knowledge

Medicare knowledge

Organizational skills

Startup environment experience

Education

Bachelor’s/Associate in Healthcare or Business

NAMSS CPMSM or CPCS preferred

Job description

Why We're Here:

At Brave Health, we are driven by a deep commitment to transform lives by expanding access to compassionate, high-quality mental health care. By harnessing the power of technology, we break down barriers and bring mental health treatment directly to those who need it most—wherever they are. As a community health-centered organization, we are dedicated to ensuring that no one is left behind. Nearly 1 in 4 people in the U.S. receive healthcare through Medicaid, yet two-thirds of providers don’t accept it. Brave Health is stepping up to close this gap by making mental health care accessible, affordable, and life-changing for all.

Job Overview

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.

Responsibilities

Provider Data Management & Credentialing

• Compile and maintain current and accurate data for all clinical providers.
• Manage credentialing documentation within databases, ensuring 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.
• Oversee and maintain payor enrollment delegation rosters, including updates for new hires and providers no longer employed by Brave Health.

Onboarding & Payor Enrollment

• 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.
• Serve as a resource for new hires, addressing questions related to payor enrollment and credentialing processes.
• Ensure the submission of current credentialing documentation during onboarding for primary source verification.

Process Improvement & Vendor Management

• Collaborate with vendors to support payor enrollment processes.
• Research new payor enrollment opportunities to enhance network participation.
• Drive process and tool improvements, adapting to the growth and evolving needs of the organization.
• Identify areas for increased efficiency, including potential outsourcing or new technology implementations to streamline operations.

Qualifications

• 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.

Preferred Skills

• 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.

What We Offer

• Comprehensive health, dental, and vision coverage.
• Generous paid time off, including parental leave.
• Fully remote, work from home position; all equipment provided!

Brave Health is very proud of our diverse team who cares for a diverse population of patients. We are an equal opportunity employer and encourage all applicants from every background and life experience to apply.