Enrollment Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Execute all components of the payor enrollment procedures for providers affiliated with the OCHIN Collaborative or contracted third parties.

• Oversee credentialing applications, confirm credentials, and maintain provider files both internally and externally with payor plans.

• Process initial credentialing and recredentialing applications in compliance with regulatory standards.

• Evaluate and review credentialing applications and accompanying documents for precision and completeness.

• Authenticate and verify provider credentials, which include licensure, DEA, specialty board certifications, professional liability, and other necessary documents.

• Detect discrepancies, perform research and follow-up, and escalate unresolved matters.

• Finalize payor provider enrollment procedures and carry out revalidations.

• Keep CAQH profiles and NPPES registrations updated.

• Manage provider data with payers and oversee plan enrollment status within the credentialing system.

• Assist OCHIN business requirements through travel for Go-Live installations or training.

⛳️ Requirements

• A minimum of three (3) years of progressive experience in Provider Enrollment; five (5) years or more preferred.

• Extensive knowledge of Provider enrollment standards (HRSA, FTCA, TJC, NCQA, etc.) is preferred.

• Certification as a Provider Credentialing Specialist (CPCS) may be required or strongly preferred; must be NAMSS, not AAPC.

• Proficiency in credentialing software and data management systems is preferred.

• Experience with New York payers is preferred.

• Familiarity with MD-Staff is preferred.

• Advanced skills in Microsoft Office Suite (Word, Excel, PowerPoint, etc.) are preferred.

• Working knowledge of Smartsheet, including data structure, formula creation, basic workflows, and automation, is preferred.

• Demonstrated experience in client-facing roles, with the ability to establish strong relationships and communicate effectively with diverse stakeholders is preferred.

• Familiarity with Jira for issue tracking and task management is preferred.

• Capability to work independently and efficiently from a home office environment.

• High-Speed Internet Service is required.

• Ability to operate in a distraction-free workplace.

• Proficiency in reading, speaking, writing, and understanding English.

• COVID-19 vaccination or an approved medical/religious exemption is required as a condition of employment.

• Completion of a 50–60-minute competency assessment before the team interview is necessary.

🏝️ Benefits

• Competitive compensation package.

• Support for a healthy work-life balance.

• Opportunities for professional growth and advancement.

• A comprehensive range of benefits.

• Ability to work remotely from home.

• Coverage for COVID-19 vaccination with a medical or religious exemption process.