Provider Enrollment Specialist

Remote

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Grand Rounds
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We are looking for a Provider Enrollment Specialist to join our finance team.  This is an exciting opportunity to join a small, collaborative team and have a direct impact at a fast growing business. 
Reporting to the Manager of Provider Enrollment, the Provider Enrollment Specialist will be responsible for ensuring the success and accuracy of our internal and external Provider Enrollment/Credentialing functions. This role will work very closely with the Provider Enrollment Manager, Credentialing Lead, contracted Payers, Revenue Cycle team, and Finance. This role is crucial in guiding the company towards scalable solutions that delight our patients and clients, as well as enable the growth of our business.

Responsibilities

  • Responsible for the timely completion of government enrollment applications for all medical and behavioral health providers and groups.
  • Update and maintain all necessary government credentialing and revalidations for all providers.  Interact with providers via phone or email as needed
  • Consistently document work assignment progress, enrollment follow-up status, and relevant in-process tasks within the specified systems and time frames.
  • Build knowledge base for payor requirements and forms.
  • Develop working knowledge of payor policies for multiple states.
  • Ability to proficiently communicate and collaborate with the RMC team, Credentialing team and Billing Partners to resolve provider denials credentialing related claims issues.
  • Participate in team huddles and ongoing process improvement.
  • Works with the Manager of Provider Enrollment when changes are needed for the Procedure manual to ensure all payor enrollment processes are documented, accurate and effective.
  • Responsible for all aspects of user online access (i.e.: PECOS/Web Portals, etc.)
  • Attend conference calls with clients as requested
  • Other duties as assigned

Requirements

  • 1-2 yrs Experience working directly with payors regarding credentialing, enrollment, and contracting
  • Demonstrated experience following up with payors on the status of applications and telehealth
  • Knowledge of CAQH, NPPES and PECOS systems
About Grand Rounds Health, Doctor On Demand and Included Health:Grand Rounds Health, Doctor On Demand and Included Health merged in 2021 to form the first of its kind integrated virtual care company to raise the standard of healthcare. Our personalized, longitudinal care services include primary care, specialty care, integrated behavioral health, everyday and urgent care, chronic condition management and prevention and 24/7 triage. We get members to the right care, at the right time through ongoing clinical navigation, expert medical opinions and care coordination.
Partnering with leading employers and health plans, we deliver unparalleled, end-to-end care. Our combined nationwide practice of dedicated clinicians and innovative data science and technology platforms provide better care experiences, better member satisfaction, and better outcomes and cost savings for our nearly 100 million covered lives across commercial, Medicare and Medicaid. 
Headquartered in San Francisco, the combined company has been recognized as a 2020 UCSF Digital Health Award winner for Employer Wellness and 2021 Best Workplaces in Healthcare and Biopharma™ by Great Place to Work and Fortune. Learn more at www.grandrounds.com and www.doctorondemand.com.
-----Grand Rounds Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Grand Rounds Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.
Job tags: Billing
Job region(s): Worldwide/Anywhere
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