Managed Care Credentialing Representative II

Job Description:

Job Title: Managed Care Credentialing Representative II

Location: Remote

Department: Managed Care

Employment Type: Full-time

Job Summary:

If you're energized by helping healthcare providers succeed and enjoy being the guiding force behind smooth, compliant onboarding experiences, this role is for you. As a Managed Care Credentialing Representative II, you'll play a critical role in supporting providers as they join and grow within our network-ensuring their journey from application to credentialing is seamless, accurate, and supportive. You'll join a compassionate, collaborative team committed to accuracy, trust, and improving access to quality care, while making a meaningful difference for both providers and the communities they serve.

In this role, you'll partner closely with providers to navigate credentialing and enrollment processes, manage and maintain detailed application files, and ensure all work aligns with regulatory standards. You'll leverage your attention to detail, organization, and customer-focused approach to support initial credentialing and timely recredentialing efforts, while maintaining complete and compliant records throughout the process.

This position offers…

• Employee Assistance Program - 24/7 counseling services, legal assistance, & financial consultation for you and your household at no cost
• Mileage Reimbursement - Company paid for work functions requiring travel
• Employee Discounts - Hotels, Theme Parks & Attractions, College Tuition
• Workplace Culture - An environment cultivating employee wellbeing, valuing each individual's humanity, and actively promoting a healthy, joyful workforce
• Additional Perks & Benefits - Scroll down to bottom of this post to learn more

Key Responsibilities:

• Guide onboarding providers through credentialing application and enrollment processes, answering questions and providing clear, supportive direction
• Complete initial credentialing and recredentialing applications while proactively monitoring progress and following up to meet required timelines
• Compile, verify, and maintain accurate provider data within credentialing databases and files
• Investigate and document practitioner credentials, including education, training, licensure, and professional history, in accordance with regulatory standards
• Communicate adverse or questionable verification findings to supervisors and leadership as needed
• Assist providers with changes to privileges or license types
• Maintain departmental standards while ensuring compliance with all applicable credentialing regulations
• Perform other related duties as assigned

Education, Experience, and/or Credential Qualifications:

• High school diploma, GED, or equivalent required
• Previous healthcare credentialing experience required
• Experience in healthcare administration utilizing advanced Microsoft Office tools, including Excel, preferred

Additional Qualifications:

• Excellent customer service, communication (oral and written), and time management skills
• Strong organizational skills with exceptional attention to detail
• Analytical ability to research industry policies and translate findings into actionable steps
• Ability to manage multiple projects concurrently while meeting varying deadlines
• Current driver's license, acceptable driving record, and current auto insurance required
• Successful completion of required background screenings, including criminal history and abuse/neglect checks

Physical Requirements

• Perform sedentary work, exerting up to 10 pounds of force occasionally and negligible force frequently
• Engage in repetitive hand, finger, and arm movements for typing and writing throughout the workday
• Sit for extended periods with occasional walking or standing as needed

Keywords: healthcare credentialing, provider onboarding, managed care, healthcare administration, credentialing specialist, provider enrollment, compliance, medical credentialing, healthcare operations

Position Perks & Benefits:

Paid time off: full-time employees receive an attractive time off package to balance your work and personal life

Employee benefits package: full-time employees receive health, dental, vision, retirement, life, & more

Top-notch training: initial, ongoing, comprehensive, and supportive

Career mobility: advancement opportunities/promoting from within

Welcoming, warm, supportive: a work culture & environment that promotes your well-being, values you as human being, and encourages your health and happiness

Brightli is on a Mission:

A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance user care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients.

As a behavioral and community mental health provider, we prioritize fostering a culture of belonging and connection within our workforce. We encourage applications from individuals with varied backgrounds and experiences, as we believe that a rich tapestry of perspectives strengthens our mission. If you are passionate about empowering local communities and creating an environment where everyone feels valued and supported, we invite you to join our mission-driven organization dedicated to cultivating an authentic workplace.

We are an Equal Employment Opportunity Employer.

Brightli is a Smoke and Tobacco Free Workplace.