Credentialing & Revenue Cycle Manager

Credentialing & Payer Enrollment

• Manage end-to-end provider credentialing and payer enrollment across multiple states and medical entities
• Maintain credentialing timelines and payer enrollment status across the provider network
• Coordinate with medical directors and credentialing bodies on initial and re-credentialing cycles
• Support payer contracting and in-network participation strategy as we expand care programs

Revenue Cycle Management

• Own the operational buildout of E&M billing for the Wellness Plus program, from claim submission through payment reconciliation
• Partner with coding, clinical, and finance teams to ensure accurate CPT and ICD-10 documentation and submission
• Monitor denial trends, conduct root cause analysis, and implement corrective workflows
• Build and maintain reporting on key RCM metrics: denial rate, days in AR, clean claim rate, net collection rate

AI and Automation

• Actively integrate AI-assisted tools into credentialing and RCM workflows, including prior authorization support, coding suggestion tools, and payer portal automation
• Identify high-volume manual processes that can be reduced through automation and partner with product and engineering to scope and ship improvements
• Evaluate new health tech tooling as the landscape evolves and bring informed recommendations to the team

Team and Cross-Functional Leadership

• Manage and develop a small team supporting credentialing and RCM operations
• Partner with insurance ops, pharmacy ops, and clinical ops on overlapping workflows
• Serve as the internal subject matter expert on payer policies, E&M billing requirements, and credentialing compliance

Requirements

• 3-5 years of experience in provider credentialing, revenue cycle management, or insurance operations
• Meaningful experience in health tech or telehealth, including building or scaling workflows in a fast-moving environment
• Has built or rebuilt a credentialing or RCM function, not just inherited one
• Hands-on experience with RCM and billing platforms (Candid or equivalent), credentialing management tools, and practice management systems
• Expert-level proficiency navigating major commercial payer portals (Availity, UnitedHealthcare Link, NaviNet) to audit claim statuses, track down stuck remittances, and resolve complex multi-network denials outside automated billing workflows
• Solid working knowledge of E&M coding, CPT/ICD-10, and CMS billing and telehealth billing guidelines
• Comfortable using and evaluating AI tools and automation platforms; has incorporated these into actual workflows
• Has managed a small team and can develop people while staying hands-on
• Strong communicator who can translate complex billing or credentialing issues into clear operational plans and executive summaries

Nice to Have

• Experience with multi-entity or multi-state provider networks
• Background in direct primary care or GLP-1/metabolic telehealth
• CPMSM, CPCS, or CRCR certification
• Experience owning or supporting prior authorization workflows and payer escalation processes