We are looking for a Provider Enrollment Specialist to join our finance team. This is an exciting opportunity to join a small, collaborative team and have a direct impact at a fast growing business. Reporting to the Manager of Provider Enrollment, the Provider Enrollment Specialist will be responsible for ensuring the success and accuracy of our internal and external Provider Enrollment/Credentialing functions. This role will work very closely with the Provider Enrollment Manager, Credentialing Lead, contracted Payers, Revenue Cycle team, and Finance. This role is crucial in guiding the company towards scalable solutions that delight our patients and clients, as well as enable the growth of our business.
Responsibilities:
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- Responsible for the timely completion of government enrollment applications for all medical and behavioral health providers and groups.
- Update and maintain all necessary government credentialing and revalidations for all providers.
- Interact with providers via phone or email as needed
- Consistently document work assignment progress, enrollment follow-up status, and relevant in-process tasks within the specified systems and time frames.
- Build knowledge base for payor requirements and forms.
- Develop working knowledge of payor policies for multiple states.
- Ability to proficiently communicate and collaborate with the RMC team, Credentialing team and Billing Partners to resolve provider denials credentialing related claims issues.
- Participate in team huddles and ongoing process improvement.
- Works with the Manager of Provider Enrollment when changes are needed for the Procedure manual to ensure all payor enrollment processes are documented, accurate and effective.
- Responsible for all aspects of user online access (i.e.: PECOS/Web Portals, etc.)
- Attend conference calls with clients as requested
- Other duties as assigned
Requirements:
- 1-2 yrs Experience working directly with payors regarding credentialing, enrollment, and contracting
- Demonstrated experience following up with payors on the status of applications and telehealth
- Knowledge of CAQH, NPPES and PECOS systems
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About Included Health
Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.
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Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.