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Credentialing and Enrollment Specialist

Eleanor Health

Eleanor Health

Posted on Tuesday, June 11, 2024

Position Description

The Credentialing and Enrollment Specialist role is responsible for the completion of credentialing and enrollment related tasks allowing providers to be in network with all market payers and improve access to community member care. This role will collaborate and directly report to the Credentialing & Enrollment Manager and provide assistance to colleagues, departments, and clinics as needed.

It is important that this role is held by an individual who can serve as a subject matter expert in healthcare credentialing and enrollment standards and is enthusiastic about working with our provider team in a fast-paced remote environment.

Candidate Responsibilities

  • Coordinate the procurement and ongoing monitoring of applicable licenses, DEA, Controlled Substance Certifications, and Collaborative Agreements.
  • Monitor and manage the electronic expirables management system to ensure renewal of all provider state licenses, DEA’s, malpractice insurance, certifications and other required expirables. Assists medical and associate staff in the renewal process as needed.
  • Review and update delegated credentialing rosters on a monthly basis.
  • Complete outreach to licensing bodies and push forward application review.
  • Ensure CAQH remains updated with accurate information.
  • Conducting regular qualitative and quantitative reviews of both internal and external workflows and ensuring adherence to our internal policies and procedures.
  • Support other responsibilities and functions of the Credentialing & Enrollment department as needed
  • Knowledge and ability to easily navigate and enroll billable providers in Medicare, Medicaid, and Commercial Insurance Plans/Networks
  • Expertise/experience with payer enrollments in various states
  • 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)
  • Ability to adapt and work with various insurance web-sites to find information as well as learn other systems used for this role.
  • Knowledge of electronic databases and systems such as CAQH, PECOS, NPPES, NPDB
  • Experience working within the Billing functions of the EHR Athena.
  • Ability to demonstrate strong research skills and gather pertinent information.
  • Ability to work independently but also collaborate with team members.
  • Display strong data entry and technology skills.
  • Detail oriented with a high degree of accuracy in all aspects of work.
  • Ability to use independent judgment and decision-making, and to know when questions require guidance and direction.
  • Strong organizational, written, verbal, problem solving and relationship building skills.
  • Ability to handle multiple assignments.
  • Ability to deal with frequent interruptions.
  • Ability to prioritize workload.

You’ll be a good fit if you:

  • At least three years of experience in healthcare credentialing and enrollment
  • Have experience serving on interdisciplinary teams and enjoy working in a collaborative environment
    • 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.
  • Are comfortable working in a fast-paced environment
  • You are flexible and adaptable and driven to succeed.

Compensation & Benefits:

This is a full-time position at 40 hours per week. The target compensation range for this position is $20-22/hour. The actual compensation offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job.

About Eleanor Health

Eleanor Health is the first outpatient addiction and mental health provider delivering convenient and comprehensive care through a value-based payment structure. Committed to health and wellbeing without judgment, Eleanor Health is focused on delivering whole-person, comprehensive care to transform the quality, delivery, and accessibility of care for people affected by addiction.

To date, Eleanor Health operates multiple clinics and a fully virtual model statewide across Louisiana, Massachusetts, New Jersey, North Carolina, Ohio, Texas, Florida, and Washington, delivering care through population and value-based partnerships with Medicare, Medicaid, and employers.

If you are passionate about providing high quality, evidence based care for individuals with substance use disorder through an innovative practice and about building a great business that makes a difference, Eleanor Health is an ideal opportunity for you. We seek highly skilled, motivated and compassionate individuals who take responsibility and adapt quickly to change to join our deeply committed and collaborative team.

Job Types: Full-Time