Credentialing/Payor Enrollment Specialist

Brave Health; Lorida (FL); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Comprehensive health, dental andvision

Fully remote, work from home

Job summary

Brave Health is seeking a Provider Data Management & Credentialing specialist to manage payor enrollment, credentialing, and re-credentialing for clinical providers, ensuring timely enrollment with Medicaid, Medicare and private payers.

Remote role with the Director of Credentialing Operations, opportunities to improve processes, leverage new tools, and support onboarding of new providers before start dates.

Qualifications

• Minimum of three years of credentialing/payor enrollment experience.
• Strong knowledge of Medicaid, Medicare, and private payer insurance systems.
• NAMSS certification preferred (CPMSM or CPCS).
• Remote work experience preferred.

Responsibilities

• Compile and maintain current data for all clinical providers.
• Manage credentialing documentation and enrollment in health plans.
• Perform primary source verification during initial credentialing and re-credentialing.
• Maintain enrollment forms and documentation.
• Partner with HR to enroll new providers before start date.
• Assist new hires with Medicaid and Medicare applications, including reassigning Medicare benefits.
• Serve as a resource on payor enrollment and credentialing processes.
• Ensure submission of credentialing documentation during onboarding.

Skills

Credentialing

Payor enrollment

Primary source verification

Process improvement

Vendor management

Education

Associate’s or Bachelor’s degree in Healthcare/Business

Job description

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. 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.

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.

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.
• 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

• 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.

Requirements

• Minimum of three years of relevant credentialing/payor enrollment experience required.
• Strong knowledge of Medicaid, Medicare, and private payer insurance systems.
• 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.

Benefits

• Comprehensive health, dental, and vision coverage.
• Fully remote, work from home position; all equipment provided!