Licensing and Credentialing ManagerBrightline is redefining what pediatric behavioral health care looks like for families across the country. None of that reach matters if a provider cannot legally practice or a payer will not pay the claim. As Manager, Licensing & Credentialing, you own the machinery that keeps every provider licensed, enrolled, and revenue-ready across every state and every payer network Brightline works with. This is a remote role with no direct reports, and it is designed as a high-level individual contributor position.Why This RoleThis is the role where precision becomes something families actually feel. Every provider you get licensed and credentialed faster is a family that gets care sooner, and every payer relationship you strengthen is revenue Brightline has already earned finally landing where it belongs. You will own the licensing vendor relationship and its budget, direct how that vendor performs rather than simply tracking it, and run payer credentialing end to end. You will keep every roster airtight and turn slow enrollments into fast ones through relationships you build yourself. You will sit at the table with Contracting, Revenue Cycle, Compliance, Clinical Operations, and Legal, representing this function as someone leadership counts on for answers. And you will own the metrics that prove it is all working, while designing the processes that let this function scale as Brightline continues to grow. If you want a role where precision is the whole point and the impact is easy to see, this is it.ResponsibilitiesLicensing ManagementOwn 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 CredentialingManage 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 ManagementOwn 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 ManagementDevelop 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 CredentialingSupport 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 ScaleOwn 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.Requirements:Bachelor's degree or equivalent combination of education and experience.5+ years of provider licensing and payer credentialing experience.Strong understanding of CAQH, NPPES, PECOS, Medicare enrollment, Medicaid enrollment, and commercial payer credentialing.Excellent communication, negotiation, and relationship management skills.Strong problem-solving and escalation management abilities.Ability to manage multiple priorities while maintaining exceptional attention to detail.Experience leading cross-functional initiatives that improve operational performance.Experience managing multi-state provider licensingExperience managing vendor relationships and delegated credentialing programs.Experience working with CertifyOS or similar credentialing software preferred.Preferred experience with: Credentialing providers through commercial and Medicaid payersPreferred experience with: Managing payer roster submissions and provider directory accuracy.We offer several benefits, perks, and stipends:Health coverage: Medical, Dental, and Vision insurance, plus Long-Term Disability, Life Insurance, a Flexible Spending Account, and a 401(k)Time to recharge: 12 Company Holidays, Floating Holidays, and Paid Time Off — plus a company-wide Holiday Shutdown between Christmas and New Year's, so you can truly unplug knowing your teammates are offline tooGrowing your family: Parental Leave to be present for what matters mostPerks & stipends: Health and Wellness Stipend, Home Office Reimbursement, License Maintenance Reimbursement, Commuter Benefits, and Professional Development Reimbursement to support how and where you do your best workAt Brightline we have built a total rewards philosophy that includes fair, equitable, competitive, geo-based compensation that is performance and potential based. Our strategy is based on robust market research, including external advisory specializing in national compensation, and thoughtful input from every level of our organization. It is a combination of a cash salary, equity, benefits, wellbeing, and opportunity. In compliance with the Equal Pay for Equal Work Act, the annual base salary range for applicants is $80,000 - 90,000.Our Commitment to Building a Diverse, Equitable, and Inclusive WorkforceAt Brightline, we believe that Diversity, Equity, Inclusion, and Belonging are essential to the foundation upon which our mission is built. We are committed to:building a future where all families can access inclusive, high-quality carecreating an environment that encourages our employees to show up authentically, reach their highest potential, and have an equal opportunity to thrivesystematically evaluating and improving our inherent beliefs, observed behaviors, structures, and systemsensuring that every employee, candidate, client, and family we serve is valued and respectedAbout BrightlineBrightline is a therapy and psychiatry practice that delivers expert pediatric, teen, and parental mental health care to families and kids up to age 18. Brightline’s virtual and in-person outpatient services include diagnostic evaluation, therapy, psychiatry services (e.g. medication management), and psychological testing (to assess learning differences, school readiness, executive functioning difficulties [e.g. ADHD], and autism). In addition to Brightline’s generalized support, we offer focused programs including those that support anxiety, obsessive compulsive disorders, ADHD, and disruptive behaviors. Founded in 2019, Brightline has delivered care to tens of thousands of families with industry-leading results. We’ve been nationally recognized for clinical excellence and innovation for several years — recent awards include the Fast Company 50 Most Innovative Companies (2022) and Behavioral Health Business Companies to Watch Award (2024). Brightline is based in Palo Alto and is backed by investors including Boston Children’s Hospital, Northwell Health, Blue Cross Blue Shield of Massachusetts, Google Ventures, KKR, and Oak HC/FT.
7 days ago