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Role Description

The Provider & Payer Services Specialist plays a critical role on the Eleanor Health Revenue Operations Team in ensuring the organization’s credentialing and enrollment activities are accurate and compliant by analyzing vendor performance, identifying discrepancies, and improving processes.

• Act as the subject matter expert (SME) for provider credentialing/accreditation/insurance regulations, policies, guidelines, and standards.
• Build and maintain strong, positive relationships with Eleanor’s Credentialing and Enrollment vendor through regular communication, meetings, and by serving as a primary point of contact.
• Proactively monitor and audit the progress of applications, follow up with the vendor as needed, and resolve any barriers or issues that arise during the enrollment and credentialing process.
• Address and resolve provider inquiries and concerns related to credentialing and/or enrollment in a timely manner.
• Facilitate communication between providers and the vendor to ensure all parties have the information needed for efficient operations and a seamless process.
• Clearly and effectively communicate with providers, Operations Managers, and internal stakeholders handling basic questions dealing with the day-to-day operation of credentialing and enrollments.
• Assist the contracting department with the initial payer application process and provide information and rosters as requested.
• Review, and update if necessary, health plan directories, agencies, and other appropriate entities for current and accurate provider information.
• Stay up-to-date with industry regulations and requirements, ensuring compliance at all times.
• Assist in preparing for and participating in audits and regulatory reviews.

Qualifications

• 1-3 years of experience in healthcare.
• Excellent communication, relationship management, and problem-solving skills.
• Knowledge of relevant federal and state regulations.
• Knowledge of CAQH, NPPES, PECOS, and payer credentialing portals.
• Strong knowledge of industry regulations, such as the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC) standards.
• An analytic mindset - interested in root cause analysis and process improvement with the ability to work with and manipulate large amounts of data.
• Solid background of developing informative and clear training/documentation materials.

Preferred

• Prior startup experience preferred.
• Medallion experience.
• Intellectual curiosity and creativity coexisting alongside critical thinking.
• An expert at building and maintaining meaningful relationships, establishing credibility, and thinking strategically.
• Ability to work both independently and collaboratively with internal teams.
• Detail oriented, committed to excellence and precision.
• Outstanding written and oral communication and presentation skills.
• Collaborative and team-oriented mindset to work effectively with cross-functional teams.
• Adaptability and ability to thrive in a dynamic environment.

Compensation & Benefits

The total target annual compensation range for this position is $55-60,000. 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.

• Generous Paid Time Off (prorated for new employees)
• 12 Vacation days
• 12 Wellness (Sick) days
• 3 Floating holidays
• 9 Company-observed holidays
• Jury Duty, Voting Leave, and other forms of paid time off may be available
• Eleanor-paid medical and dental insurance plans, with affordable vision coverage.
• 401(k) plan with 3% match.
• Short-term disability.
• Long Term Disability - Picks up where Short Term Disability leaves off (employee paid).
• Life Insurance - Both Eleanor and employee-paid options are available.
• Family Medical Leave - Eleanor Health’s Paid Family & Medical Leave (“PFML”) is designed to provide flexibility and financial peace of mind for approved family and medical reasons.
• Wellness Perks & Benefits - Mental Health is important to us and we want our employees to have the accessibility you deserve.
• Mindfulness App Reimbursement
• EAP with eight face-to-face sessions
• Virtual health and wellness visits covered by our medical plan.