hellobrightline - Licensing and Credentialing Manager

• Licensing Management • Own the CertifyOS vendor relationship, including budget accountability and renewal negotiations. • Direct the day-to-day work CertifyOS performs on Brightline's behalf and hold the vendor accountable to defined service levels. • Oversee all provider licensing and license renewals across multiple states. • Ensure timely submission, tracking, and renewal of provider licenses. • Monitor vendor performance against established service level agreements (SLAs). • Partner with internal stakeholders to ensure providers are licensed before scheduled start dates. • Identify opportunities to improve licensing workflows through automation and process optimization. • Maintain accurate licensing records and ensure compliance with all state licensing board requirements. • Provider Credentialing • Manage all commercial, Medicaid, and managed Medicaid payer credentialing activities. • Personally oversee provider enrollment, re-credentialing, and payer applications from submission through approval. • Track credentialing status and proactively resolve enrollment delays. • Ensure providers are credentialed and billable prior to delivering patient care whenever possible. • Maintain complete and accurate credentialing documentation. • Monitor re-credentialing timelines to prevent credentialing lapses. • Payer Roster Management • Own payer roster management across all contracted health plans. • Ensure provider roster submissions are accurate, timely, and synchronized with payer systems. • Coordinate provider additions, terminations, demographic updates, tax ID changes, and location updates with contracted payers. • Perform routine payer roster audits to identify and correct discrepancies. • Partner with Revenue Cycle teams to resolve billing issues resulting from roster inaccuracies. • Establish standardized processes for roster maintenance as the organization scales. • Payer Relationship Management • Develop and maintain strong relationships with commercial and government payer credentialing representatives. • Lead recurring monthly payer operational meetings focused on credentialing escalations, enrollment turnaround times, provider roster accuracy, re-credentialing performance, and process improvement opportunities. • Serve as the organization's primary escalation point for payer credentialing issues. • Represent the licensing and credentialing function in cross-functional forums with Contracting, Revenue Cycle, Compliance, Clinical Operations, and Legal, speaking for the function's priorities and status rather than simply coordinating within it. • Partner closely with those teams to resolve payer related issues impacting provider enrollment. • Delegated Credentialing • Support the development of delegated credentialing programs with contracted payers. • Collaborate with Compliance and Quality teams to ensure delegated credentialing requirements are met. • Coordinate payer audits and maintain audit readiness. • Accountability and Scale • Own and report on the core metrics that define whether the function is working, including days to credential, license renewal on-time rate, and payer roster accuracy rate. • Define the processes, documentation, and workflows this function runs on today, built so they hold up as provider volume, state coverage, and payer relationships continue to scale. • Bring metric trends and process gaps to leadership proactively, rather than only when an issue has already caused a delay.