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

📋 Description

• Manage the comprehensive health plan enrollment process, from obtaining applications to notifying clients, by collaborating with external vendor partners.

• Address highly escalated enrollment requests directly as necessary.

• Track in-progress enrollments via phone, email, and portal follow-ups while ensuring timely documentation in Medallion systems.

• Maintain thorough knowledge of payer-specific enrollment criteria, prerequisites, forms, completion standards, supporting documentation, and regulations.

• Keep supporting documentation updated in provider profiles, including onboarding documents, application copies, welcome letters, and correspondence.

• Prepare client updates regarding enrollment status and progress.

• Develop relationships with payer representatives and contracting departments to enhance submission and approval timelines.

• Assist in revalidation processes to ensure active provider participation in health plans.

• Monitor payer enrollment timelines and deadlines for compliance.

• Investigate and resolve issues related to enrollment delays, rejections, and discrepancies with providers, payers, and vendor partners.

• Stay informed about payer policies, state and federal regulations, and enrollment best practices.

• Carry out other assigned responsibilities.

⛳️ Requirements

• Understanding of payer enrollment-related applications and processes, typically requiring at least 3+ years of direct enrollment experience.

• Proficiency in GSuite tools including Google Sheets, Google Docs, and Gmail.

• Detail-oriented with the ability to ensure that complex enrollment packages are complete and accurate.

• Effective communication skills to engage with a diverse range of internal and external contacts at all organizational levels.

• Must be able to work collaboratively in a team-oriented environment and cultivate positive working relationships with colleagues both within and outside the organization.