Sr. Manager, Credentialing Operations at Finni Health · LumiJobs

Responsibilities

This is a build job as much as a leadership job. Too much of how this function works today lives in a few people's heads, our reports do not always agree with each other, and the controls that should make it safe when someone is out are not all in place. You are here to run it and to make it durable.
Team Leadership: Hire, develop and set the performance bar across managers and coordinators. Build the bench this function has not had.
Completing the Reorganization: The function is moving from managers aligned to groups of practices to managers who each own one stage of the lifecycle. That transition is in flight and you will finish it. The hard part is not the org chart, it is keeping the state and payer knowledge that currently lives with a group-aligned manager while the work is re-cut around stages.
Time to Enrolled: Own the number, meaning the days from a provider signing their offer to being enrolled with a given payer. Underneath it: blocked billing by cause, clean submission rate, aging and follow-up compliance. You own whether the number is right, not just whether the dashboard renders.
Reporting We Can Trust: Reconcile the places our systems disagree about the state of an enrollment, and keep them reconciled.
Controls and Coverage: Remove the single points of failure. The review queues, the payer configuration that governs who may bill, and the approvals that keep an unenrolled provider off a schedule should never depend on one person being at their desk. Build the cross-training, segregation of duties, and second set of eyes that make that true.
Data-Handling and Payer Restrictions: A growing list of payers and state Medicaid programs prohibits offshore handling of protected health information. You will own the restricted-payer list, enforce it in how work is actually assigned rather than in policy alone, and tell us when the only answer is an onshore hire.
Process and Documentation: Build the per-payer requirements library so a submission goes out as soon as that payer's minimum is met instead of waiting on the strictest payer on the list, plus written procedures by state and payer specific enough that a coordinator who has never worked a given state can submit there.
Backlog Programs: Enrollment records without documented proof of network participation, enrollments still open on providers who have left, records with no approval date. Scope each one, run it to completion, and prevent it from recurring.
Payer Relationships and Compliance: Provider-level revalidations, roster management, directory accuracy, demographic updates, and the judgment that comes with them. When a payer offers something like provisional credentialing, you weigh the risk and make the recommendation.
Product Partnership: Be the credentialing voice in Product. Translate what the team needs into requirements engineering can build, and verify the build solved the problem before it is called done. Our enrollment systems are mid-migration and there is real work here.
Cross-Functional Collaboration: Work closely with Practice Success, revenue cycle, payer contracting, HR and compliance.

Qualification

ExperiencePeople LeadershipReorganizing a TeamProcess BuildingAnalytical and Problem-SolvingCompliance JudgmentOffshore TeamsCommunication and CollaborationTech ProficiencyMission AlignmentAdaptability and AgilityWHAT SUCCESS LOOKS LIKE

Required

Experience: 5+ years in provider credentialing or payer enrollment, multi-state, across commercial payers and Medicaid or Medicaid managed care. Medicaid experience is required. Hands-on with CAQH, NPPES, PECOS, state Medicaid portals and commercial payer portals. You have submitted applications yourself and you know where they stall.
People Leadership: 2+ years managing and developing a team, ideally including leads or managers rather than only individual contributors. Be ready to tell us about someone you developed and someone you had to move on from.
Reorganizing a Team: You have changed how a team is structured, not just who is on it. Moving people from one way of dividing the work to another, keeping the knowledge that lived in the old structure, and holding the change in place after the announcement.
Process Building: Demonstrated expertise in identifying inefficiencies and building the fix, not only naming it. SOPs that got used, a workflow you designed, an SLA you set and then held a team to.
Analytical and Problem-Solving: Strong ability to work with operational data, identify trends and root causes, and implement data-driven solutions. You can define a metric, notice when a number looks wrong, and go find out why.
Compliance Judgment: You understand that credentialing is a control function. Delegated credentialing, NCQA standards, payer audits and data-handling restrictions are familiar territory, and you treat a bypassed guardrail as a serious finding rather than a convenience.
Offshore Teams: Experience leading or working closely with offshore teams, and an honest view of what works and what does not.
Communication and Collaboration: Excellent written and verbal communication, with proven ability to work across internal teams and with external stakeholders including payers. Much of what this role produces is written.
Tech Proficiency: Proficient in Google Suite, Slack, and credentialing platforms such as Verifiable, Medallion, Modio, Symplr or CAQH ProView, with an opinion about what these tools do and do not do well. Experience writing requirements for a product or engineering team is a plus.
Mission Alignment: Passion for Finni's mission to democratize autism care and empower providers to run strong, compliant practices.
Adaptability and Agility: Comfortable thriving in a dynamic, fast-paced startup environment, embracing change, and navigating ambiguity with a proactive mindset.
WHAT SUCCESS LOOKS LIKE

Sr. Manager, Credentialing Operations

Responsibilities

Qualification

Required

Benefits

Company

Finni Health

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