Credentialing and Enrollment Specialist

Summary

Join Eleanor Health as a Credentialing & Enrollment Specialist and ensure providers are in-network with all market payers, improving community member care access. You will be responsible for completing internal credentialing and payer enrollment tasks, adhering to Eleanor standards and regulatory compliance. This role requires expertise in healthcare enrollment standards and involves workflow review, application completion, provider credential verification, and communication with payers and providers. You will also support Athena provider setup, maintain records, conduct research on regulations, and help develop internal processes. The ideal candidate has at least three years of experience in healthcare credentialing and enrollment and enjoys working collaboratively.

Requirements

• At least three years of experience in healthcare credentialing and enrollment
• Have experience serving on interdisciplinary teams and enjoy working in a collaborative environment

Responsibilities

• Review and update delegated credentialing rosters on a monthly basis
• Complete enrollment applications as needed and coordinate with internal providers to gather required documentation
• Verify and maintain the credentials of healthcare providers, ensuring they meet industry standards and regulatory requirements
• Update provider information in systems and notify relevant parties of changes
• Stay informed about payer requirements, policies, and regulations
• Follow up with payers and providers to resolve issues and ensure timely processing of applications
• Track provider status, including enrollments, re-enrollments
• Complete outreach to external bodies and push forward application review
• Ensure CAQH remains updated with accurate information for each of our active providers
• Support Athena provider set up and maintenance & credentialing and enrollment tasks
• Support other responsibilities and functions of the Credentialing & Enrollment department as needed
• Create and maintain licensing, credentials and insurance records
• Conduct research on updated state and federal regulations and policies
• Release information to requesting agencies and public inquiries when required by law
• Help develop internal credentialing processes
• Monitor license and credential expiration dates and advise staff members of required “renew by” dates
• Ensure the facility and staff members are maintaining compliance with regulatory and accrediting institutions

Preferred Qualifications

• Expertise/experience with payer enrollments in various markets
• Experience communicating with payers and troubleshooting barriers to enrollment, reimbursement, etc
• Experience with a third party vendor completing elements of credentialing and enrollment (ideally: Verifiable/Salesforce knowledge)
• Experience with G Suite and Monday.com is preferred
• Well versed with PECOS and Medicare enrollment
• Experience applying and navigating CAQH, NPDB, and NCQA standards
• NPPES NPI Registry knowledge
• Experience working within the Billing functions of the EHR Athena
• Independent, Self-starter
• Organized
• Critical thinking/problem solving skills
• Ideally: SUD and Behavioral Health experience
• Enjoy finding opportunities to improve, developing solutions, and communicating those opportunities to peers & leaders in an actionable and collaborative way
• Enjoy meeting new people and establishing mutually beneficial working relationships
• Have experience working in a startup environment, flexible, adaptable

Benefits

• This is a full-time position at 40 hours per week
• The target compensation range for this position is $20-24/hour