Key Responsibilities:
1. End-to-End Enrollment Management
● Manage the full-cycle payer enrollment and revalidation process for healthcare providers
(Physicians, NPs, PAs, RNs, CRNAs, etc.).
● Prepare, review, and submit enrollment applications across Commercial and/or Medicaid
payers.
...
● Track application progress, follow up with payers, and maintain accurate, up-to-date
documentation. 2. Compliance & Regulatory Adherence
● Ensure compliance with federal, state, and payer-specific policies and guidelines.● Stay updated on changes in payer rules, Medicaid regulations, CAQH requirements, and
credentialing standards.
● Conduct data quality checks prior to submission to minimize risks of rejections or delays. 3. Issue Resolution & Escalations
● Investigate and resolve complex enrollment issues—rejections, NPI/taxonomy
discrepancies, retro-effective enrollment, and portal conflicts.
● Serve as a point of escalation for difficult payer inquiries.
● Coordinate with internal Quality, Credentialing, and Provider Data teams to address
blockers. 4. Process Improvement
● Identify inefficiencies in the enrollment workflow and recommend enhancements to
reduce turnaround time and improve accuracy.
● Support automation and system-improvement initiatives.
● Contribute to building standardized templates and best practices. 5. Mentorship & Team Support
● Guide and mentor junior Analysts to improve their technical and process knowledge.
● Provide feedback through reviews, quality checks, and coaching discussions.
● Participate in team huddles, calibrations, and performance alignment meetings. 6. Documentation & Reporting
● Maintain accurate records within CRM, internal workflow tools, payer portals, and
tracking sheets.
● Generate periodic reports on submissions, status updates, pending items, and
escalations.● Ensure documentation meets audit and compliance expectations. Preferred Skills:
● Working knowledge of credentialing processes, provider data workflows, or RCM.
● Experience in healthcare operations, BPO/health-tech environments, or centralized
enrollment teams.
● Strong Excel/Google Sheets capabilities for tracking and reporting.
experience
8show more
Key Responsibilities:
1. End-to-End Enrollment Management
● Manage the full-cycle payer enrollment and revalidation process for healthcare providers
(Physicians, NPs, PAs, RNs, CRNAs, etc.).
● Prepare, review, and submit enrollment applications across Commercial and/or Medicaid
payers.
● Track application progress, follow up with payers, and maintain accurate, up-to-date
documentation. 2. Compliance & Regulatory Adherence
● Ensure compliance with federal, state, and payer-specific policies and guidelines.● Stay updated on changes in payer rules, Medicaid regulations, CAQH requirements, and
credentialing standards.
● Conduct data quality checks prior to submission to minimize risks of rejections or delays. 3. Issue Resolution & Escalations
● Investigate and resolve complex enrollment issues—rejections, NPI/taxonomy
discrepancies, retro-effective enrollment, and portal conflicts.
● Serve as a point of escalation for difficult payer inquiries.
● Coordinate with internal Quality, Credentialing, and Provider Data teams to address
blockers. 4. Process Improvement
● Identify inefficiencies in the enrollment workflow and recommend enhancements to
...
reduce turnaround time and improve accuracy.
● Support automation and system-improvement initiatives.
● Contribute to building standardized templates and best practices. 5. Mentorship & Team Support
● Guide and mentor junior Analysts to improve their technical and process knowledge.
● Provide feedback through reviews, quality checks, and coaching discussions.
● Participate in team huddles, calibrations, and performance alignment meetings. 6. Documentation & Reporting
● Maintain accurate records within CRM, internal workflow tools, payer portals, and
tracking sheets.
● Generate periodic reports on submissions, status updates, pending items, and
escalations.● Ensure documentation meets audit and compliance expectations. Preferred Skills:
● Working knowledge of credentialing processes, provider data workflows, or RCM.
● Experience in healthcare operations, BPO/health-tech environments, or centralized
enrollment teams.
● Strong Excel/Google Sheets capabilities for tracking and reporting.
experience
8show more
