Provider Enrollment Specialist

About The Role

We’re looking for an experienced Provider Enrollment Specialist who is passionate about improving the landscape for mental healthcare. In this role you’ll own the credentialing processes for 10-20 of our payors so you’ll play a key role in getting our providers in-network with some of the country’s largest health plans. Responsibilities include:

• Ensuring our providers are credentialed in a timely manner by monitoring and maintaining the end-to-end submission process for 10-20 of our payors.

  • Monitor our submission processes to make sure that all applications are submitted within SLA. Understand our submission protocols and update them as needed. Manage Virtual Assistants/BPO throughout this process.

  • Monitor the follow up process applications and communicate with the payors directly to ensure that applications are staying on-track.

  • Conduct regular reviews to validate the accuracy of our internal credentialing data against the payor’s data to ensure our credentialing data serves as a source of truth across the organization.

  • Maintain documentation for each process to ensure smooth operations.

  • Work with the Revenue Cycle Management team on any Credentialing related claim denials.

• Assist in building out new payor operations as we onboard new payors.

  • Create the Submission Protocol for new payors so that applications can be submitted in a standardized format.

  • Work with the payor to understand the best way to follow up on applications and document the process accordingly.

  • Determine the best way to regularly review the accuracy of internal credentialing data whether it be requesting a report from the payor or checking a portal.

• Provide a synthesis of each payor’s credentialing operations to the Manager Provider Enrollment on an as needed based off the data you’re monitoring in our credentialing system

• Manage special projects as needed

You’d be a great fit if...

• You’re a behavioral health enrollment expert. You’ve communicated with payors directly in the past and you meet the following requirements:

  • Certified Provider Credentialing Specialist (CPCS) with at least two years of experience in Provider Enrollment OR at least four years of experience in Provider Enrollment

  • Strong familiarity with credentialing processes terminology and primary source verification resources; these include: CAQH NPDB PECOS State Licensing Accreditation and Certification agencies

• You’re great at problem perception and escalating when you need help. You know when you need to loop someone in because you’re not getting what you need or something seems off.

• You have excellent communication skills.  You have the ability to be persuasive and credible with a wide variety of audiences both internal and external.

• You know how to hold people accountable. You drive clarity on what’s needed to get something done and you ensure deadlines are met.

• You’re tech savvy. You’ve efficiently learned new software in the past and you’re willing to learn HubSpot Verifiable Slack and Excel if you don’t know how to use them already.

• You’re comfortable with a face-paced high growth environment.

Role Details: Employment Type: Full Time Non-Exempt Base Compensation: The base compensation range for this position is $26.44 - $29.81 USD Hourly

The base compensation for this role will vary depending on several factors including relevant experience qualifications and the candidate's working location.