Credentialing Manager

What You’ll Be Doing: 

We’re looking for an experienced Credentialing Manager who is passionate about improving the landscape for mental healthcare. In this role, you’ll own the provider enrollment processes for all of our non-delegated payors, so you’ll play a key role in getting our providers in-network with some of the country’s largest health plans.

Responsibilities include:

• Build out and lead a team of Credentialing Specialists, who will be the point of contact for 5-10 payors in order to ensure our providers are credentialed in a timely manner
• Hire, train, and manage a team of Credentialing Specialists (initially 2-4 hires)
• Develop and oversee our enrollments metrics for each payor in order to determine the health of our credentialing processes
• Work with the Credentialing Specialists to build out new protocols as we expand to work with new payors
• Oversee regular reviews to validate the accuracy of our internal credentialing data against the payor’s data to ensure our credentialing data serves as a source of truth across the organization
• Work with the Revenue Cycle Management team on any patterns of claim denials that may be related to Credentialing
• Serve as an escalation point for the Credentialing Specialists as payor-related issues arise
• Oversee our Data Entry team (10-15 people), who is responsible for CAQH updates, document sorting, and application submission
• Build out clear hiring and performance metrics for the data entry team
• Partner with the Senior Manager, Credentialing Operations to run time studies of credentialing onboarding workflows to identify areas for improvement
• Partner with the Data team to build new dashboards and reports to help our Credentialing organization run most efficiently
• Provide a synthesis of these reports to the Senior Manager, Credentialing Operations on a regular basis

Salary range: $105-$128k

You'll Be a Good Fit If:  

• You’re a behavioral health credentialing expert. You’ve communicated with payors directly in the past, and you meet the following requirements:
• Certified Provider Credentialing Specialist (CPCS) with at least four years of experience in Provider Credentialing OR at least six years of experience in Provider Credentialing
• Strong familiarity with credentialing processes, terminology and primary source verification resources; these include: CAQH, NPDB, PECOS, State Licensing, Accreditation and Certification agencies
• You know your way around managing a team. You’re well versed in hiring, training new employees and performance management.
• You’re great at identifying areas for improvement then revamping operations appropriately to achieve the goal.
• You have excellent communication skills.  You have the ability to be persuasive and credible with a wide variety of audiences both internal and external.
• You know how to hold people accountable. You drive clarity on what’s needed to get something done, and you ensure deadlines are met.
• You’re tech savvy. You’ve efficiently learned new software in the past, and you’re willing to learn HubSpot, Verifiable, Slack, and Excel if you don’t know how to use them already.
• You’re comfortable with a face-paced, high growth environment.

If you don’t meet every single requirement, but are still interested in the job, please apply. Nobody checks every box, and Grow believes the perfect candidate is more than just a resume.