Provider & Payer Services Specialist

Eleanor Health

2d•$55,000 - $60,000

About The Position

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.

Requirements

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

Nice To Haves

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.

Responsibilities

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

Benefits

Generous Paid Time Off (prorated for new employees) - unplug, relax, and recharge!
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 - We are a health first company, and we strive to make our plans affordable and accessible.
401(k) plan with 3% match - We are excited to be able to support the long-term financial well-being of our team in a way that reinforces Eleanor’s commitment to equity.
Short-term disability - We understand that things happen, we want you to feel comfortable to take time to get better.
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 such as the birth, adoption, or fostering of a child, and for serious health conditions that you or a family member/significant other might be facing.
Wellness Perks & Benefits - Mental Health is important to us and we want our employees to have the accessibility you deserve to talk things through, zen with a mindfulness app, or seek assistance from health advocates
Mindfulness App Reimbursement
EAP with eight face-to-face sessions
Virtual health and wellness visits covered by our medical plan.