Provider and Health Plan Operations Specialist

Reperio Health

50d

About The Position

The Provider and Health Plan Operations Specialist supports provider credentialing, payer contracting, and operational execution across multiple states and health plans. You'll complete credentialing applications with commercial carriers, maintain payer relationships, support providers through the enrollment process, and ensure seamless operational execution. This role reports to the Senior Vice President of Provider and Health Plan Operations.

Requirements

• Strong attention to detail and accuracy
• Excellent time management and ability to prioritize competing deadlines
• Professional communication skills with internal and external stakeholders
• Process-oriented with strong organizational skills
• Comfort navigating multiple systems and platforms
• Collaborative team player

Nice To Haves

• Experience with provider credentialing or payer enrollment
• Familiarity with CAQH ProView, Availity, or similar credentialing platforms
• Healthcare operations or health plan experience
• Knowledge of state licensing requirements and payer policies

Responsibilities

• Complete credentialing applications and gather required documentation (licenses, certifications, malpractice insurance, NPIs, tax documents)
• Track application status, follow up with payers, and maintain organized credentialing files
• Serve as a point of contact for providers on credentialing and enrollment matters
• Navigate payer-specific systems and portals including CAQH ProView and Availity
• Build relationships with payer representatives and document all communications
• Support quality assurance initiatives and maintain compliance documentation

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed