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Credentialing and Enrollment Specialist

Credentialing and Enrollment Specialist

Eleanor HealthBoston, MA, US
17 days ago
Job type
  • Full-time
Job description

Job Description

Job Description

Position Description

The Credentialing & Enrollment Specialist role is responsible for completion of internal credentialing and payer enrollment related tasks allowing providers to be in network with all market payers and improve access to community member care. It is essential that you are well versed in the internal Eleanor standards and workflows and ensure that your responsibilities and credentialing and enrollment workflows are in compliance with state, federal, and accreditation bodies' standards and reflection of EH core values. 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 enrollment standards and is enthusiastic about organizing and managing the transfer and completion of tasks.

This role will involve conducting regular qualitative and quantitative reviews of both internal and external workflows and ensuring adherence to our internal policies and procedures.

Valued Characteristics and skills include :

  • 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

Specifically you will :

  • 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

    • 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, flexible, adaptable

    • Compensation & Benefits :

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

    Our mission at Eleanor Health is to help anyone affected by addiction live an amazing life. We are passionate about transforming the quality, delivery, and accessibility of addiction treatment.

    Eleanor Health is a best-in-class substance use disorder (SUD) care provider, utilizing Medication-Assisted Therapy (MAT), behavioral health therapy, and broader wellness and social support. Eleanor delivers accessible, evidence-based, and clinically excellent care supported by innovative technology, as a multi-site clinical provider. Eleanor offers community members a sustainable path to recovery, by addressing behavioral and social determinants of substance use, in tandem with medical needs.

    Job Types : Full-Time

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    Credentialing Specialist • Boston, MA, US