What You Will Be Doing:As a Credentialing Manager (Individual Contributor), you will play a critical role in optimizing our revenue cycle operations. Your primary responsibilities will include:
- Payer Network Management: Drive efforts to scale Finni's network of insurance contracts and unblock stalled applications with payers, ensuring efficient onboarding and ongoing relationship management.
- Offshore Team Management: Oversee enrollment submission team to ensure productivity expectations are met, active payer follow-up is timely, consistent, accurate, and recorded in the credentialing platform.
- Customer Triage: Triage questions around payer enrollment updates, status, and general questions for providers and their respective support staff
- Compliance and Quality Assurance: Ensure strict adherence to payer regulations, industry standards (e.g., CMS billing, NCQA Guidelines, Delegated Credentialing), and internal policies, maintaining high service and compliance standards across all RCM functions.
- Operational Efficiency and Project Management: Lead workflow optimization initiatives within RCM, manage specific projects, and drive continuous process improvements to maximize reimbursement and minimize denials.
- Cross-Functional Collaboration: Collaborate extensively with product, provider success, compliance, HR, finance, and other teams to align RCM efforts with overall business objectives and drive strategic goals.
- Additional Responsibilities: Adapt and take on evolving responsibilities and projects as Finni Health grows and the RCM landscape changes.
About You:You are a proactive and collaborative individual contributor with a strong background in revenue cycle management, driven by a commitment to operational excellence and financial performance.
- Experience:5+ years of relevant experience in credentialing or related roles, preferably in an early-stage startup, behavioral or mental health, or healthcare tech. Strong understanding of the payer credentialing processes, including core credentialing prerequisites, credentialing blockers and solutions to remediate, roster management, and demographic updates. Medicaid experience is required.
- Collaborative & Independent Contribution: Proven ability to work effectively within a team environment, contributing to collective success, and independently driving credentialing initiatives.
- RCM Expertise: Deep understanding of the full revenue cycle, including billing, claims processing, collections, accounts receivable management, payer contracting, and compliance (e.g., CMS billing).
- Analytical & Problem-Solving: Strong ability to analyze complex RCM data, identify trends, root causes of issues, and implement effective, data-driven solutions to optimize financial performance.
- Process Optimization: Demonstrated expertise in identifying inefficiencies and driving process improvements for RCM efficiency and effectiveness.
- Communication & Collaboration: Excellent written and verbal communication skills, with proven ability to effectively collaborate with internal teams and external stakeholders (payers, vendors, providers).
- Organizational & Time Management: Exceptional organizational and time management skills, with the ability to manage multiple priorities and projects in a fast-paced environment.
- Tech Proficiency: Proficient in Google Suite, Slack, CRM/support software, and EHR/RCM management tools. Experience with various EMR/EHR work queue management within RCM is a plus.
- Mission Alignment: Passion for Finni's mission to democratize autism care and empower providers through robust RCM.
- Adaptability & Agility: Comfortable thriving in a dynamic, fast-paced startup environment, embracing change, and navigating ambiguity with a proactive mindset.
Ready to make a significant impact at a rapidly growing healthcare startup? We'd love to hear from you!
