CareTalk Health

Credentialing Specialist

• Manage full-cycle provider credentialing and recredentialing processes in compliance with CMS, NCQA, and state regulatory requirements
• Oversee medical payer enrollment activities, ensuring timely and accurate submission of applications to commercial payers and government entities (e.g., Medicare)
• Complete and manage PECOS and CMS 855i enrollments and updates
• Partner with providers to maintain and update CAQH profiles to ensure accuracy and attestation compliance
• Maintain and track provider records in credentialing databases, ensuring data integrity, accuracy, and confidentiality
• Track and manage active licenses and expiration dates via Modio for:
• Physicians and Advanced Practice Providers
• Registered Nurses (RNs)
• Licensed Vocational Nurses (LVNs)
• Licensed Practical Nurses (LPNs)
• Proactively monitor expirations and coordinate renewals via Modio to ensure uninterrupted compliance and ability to practice
• Maintain working knowledge of all 50-state licensure and practice requirements impacting telehealth delivery
• Research and interpret state-specific regulations, including:
• Nurse Practitioner collaborative/supervisory agreement requirements
• Scope of practice variations by state
• Establish and maintain processes to ensure compliance with varying state laws and regulatory updates
• Coordinate and manage collaborative agreements in accordance with state-specific requirements
• Monitor credentialing status and proactively resolve issues or delays with payers and regulatory agencies
• Conduct thorough review of credentialing applications in alignment with NCQA and accreditation standards
• Maintain provider data across platforms including CAQH, NPPES, PECOS, and payer portals
• Maintain comprehensive databases of provider information, ensuring accuracy and confidentiality
• Handle sensitive information with strict adherence to HIPAA and healthcare privacy standards
• Collaborate cross-functionally with recruiting, operations, and compliance teams to ensure timely onboarding

Licensing & Credentialing Specialist

Nurse

• Assessing patient conditions: Conduct monthly assessments of patients with chronic conditions to identify changes in their condition, needs, and concerns.
• Developing care plans: Collaborate with the patient, family, and healthcare team to develop and implement individualized care plans that address the patient’s unique needs and goals.
• Coordinating care: Coordinate care with other healthcare professionals, such as physicians, specialists, and other nurses, to ensure comprehensive and continuum care.
• Providing patient education: Educate patients and their families on self-management techniques, medication management, and health promotion strategies to improve health outcomes.
• Monitor Vital Sign of patients that are receiving remote patient monitoring.
• Document information in the medical record as appropriate.
• Collect adherence percentage data for the patient’s quarterly visit with provider.
• Work in collaboration with a registered nurse to update patient care plan.
• Assist in setting up new patient charts.
• Make calls to patients as needed.
• Accurately and comprehensively document all findings, assessments, and discussions in the electronic health record (EHR) system.
• Maintain clear and professional communication with patients throughout the virtual visit and appointment scheduling process.
• Act as a liaison between patients and healthcare providers, conveying relevant information to ensure continuity of care.
• Engage patients in a compassionate and empathetic manner to build trust and rapport.
• Ability to prioritize tasks effectively in a busy healthcare environment.
• Efficiently managing patient schedules, follow-ups, and care plans.

Licensed Practical/Vocational Nurse

Medical Billing and Coding

• Responsible for accurate and compliant coding of telehealth encounters
• Ensure proper assignment of ICD-10, CPT, and HCPCS codes
• Supports quality-measure capture and compliance with CMS, HEDIS, and payer-specific requirements
• Develop and implement a compliant coding program
• Perform encounter coding and review
• HEDIS gap-closure coding and validation
• Conduct documentation audits
• Ensure adherence to coding guidelines and participate in internal audits
• Provide coding support and education to providers and staff

Telehealth Medical Coder – CRC Required

• Manage medically complex patients, develop and monitor care plans across multiple programs (CCM, RPM, RTM, APCM)
• Complete AWV chart preparation
• Actively work to close care gaps, coordinate orders, and support preventive and chronic care initiatives.
• Prepare comprehensive AWV charts to support provider efficiency and CMS compliance
• Review and summarize with patients in face-to-face virtual visits via Zoom
• Communicate concise patient summaries and key findings to providers before each AWV
• Provide telephonic and portal-based care management for medically complex patients
• Conduct comprehensive nursing assessments addressing physical, functional, psychological, social, environmental, and learning needs
• Develop, implement, and monitor individualized care plans for CCM, RPM, RTM, and APCM
• Monitor patient progress, reassess goals, identify barriers, and adjust care plans as needed
• Provide patient education, coaching, and support aligned with health literacy and cultural needs
• Act as a patient advocate and assist with problem-solving

Registered Nurse – Virtual Care, Care Management

• Manage medically complex patients and develop care plans
• Complete AWV chart preparation and conduct assessments
• Provide telephonic care management and patient education
• Coordinate care and close care gaps

Registered Nurse – Care Management, Evening, Overnight Schedule

Customer Support

• Serve as the central coordinator for multiple care teams at once, ensuring patients are connected with the right clinician at the right time.
• Drive patient engagement by keeping the flow of visits moving smoothly across several concurrent schedules.
• Transfer patients to the appropriate care team members using call handling tools and provide real-time intake information.
• Notify the RN when a patient is ready, track the status of each visit, and anticipate next steps to prevent delays.
• Monitor call activity across teams and proactively support timely handoffs from RN to provider.
• Escalate scheduling conflicts, clinical concerns, or patient-related issues promptly to protect care quality and efficiency.
• Initiate outbound calls to scheduled patients to confirm appointments, verify identity, and ensure readiness for the visit.
• Conduct pre-visit intake, including review of demographics, consent, and any required pre-screening questions.
• Perform technology checks when appropriate (e.g., audio, video readiness) to prevent delays during the visit.
• Set a professional, welcoming tone that builds trust and positions the patient for a positive care experience.
• Take inbound calls to assist patients with questions about their visit, scheduling, or technical navigation.
• Maintain accurate documentation of patient outreach, intake, call routing, and handoff activities in the designated system(s).
• Provide real-time updates to the clinical team on patient status and any scheduling adjustments.
• Support patient satisfaction by answering questions or redirecting concerns to the appropriate resource.
• Use tools to route patients per clinical workflow.
• Troubleshoot minor technical issues (e.g., patient audio or video) and escalate as needed.
• Communicate with patients and care team members via internal chat or phone to coordinate activities.

Patient Support Specialist

Revenue Cycle Specialist

• Support claim submission to ensure timely, accurate billing
• Monitor claim status and follow up on unpaid or denied claims
• Assist with provider credentialing and payer enrollment, keeping documentation and records current
• Manage accounts receivable, including aging follow-up, collections, and resolution of outstanding balances
• Support denial management by identifying issues, documenting trends, and escalating complex cases
• Post payments, adjustments, and remittance information accurately
• Reconcile billing discrepancies and resolve account issues
• Verify patient eligibility, insurance information, and benefits as part of the insurance workflow
• Maintain documentation of billing activity, follow-up efforts, and account status
• Communicate with payers, vendors, and internal teams on claim issues and payment delays
• Help track key RCM metrics such as clean claim rate, denials, days in A/R, and collections
• Support process improvement efforts to increase efficiency and reduce billing errors
• Ensure all work complies with company policies and applicable healthcare regulations

Junior Revenue Cycle Management, RCM Specialist

General

• Efficiently schedule and coordinate medical appointments between patients and healthcare providers.
• Help the patient complete a Health Risk Assessment (HRA) to prepare the doctor before the visit.
• Answer calls from patients and prospective patients, rescheduling appointments, and documenting all interactions.
• Facilitate effective communication between patients, healthcare providers, and other team members.
• Additional responsibilities may be assigned as needed.

Patient Engagement Specialist

Call Center Representative

• Supervise patient-facing employees and contractors (providers, nurses, or clinical support staff) delivering telehealth visits.
• Lead daily operational huddles, shift readiness, and real-time issue resolution.
• Monitor staffing coverage, schedules, and adherence to ensure service-level targets are met.
• Identify and resolve operational gaps impacting visit completion, wait times, or patient experience.
• Own key operational KPIs (e.g., visit completion, productivity, wait time, adherence).
• Analyze performance trends, identify root causes, and drive corrective action.
• Provide clear, actionable feedback through coaching and performance discussions.
• Reinforce standardized telehealth workflows, documentation requirements, and HIPAA compliance.
• Ensure teammates follow established escalation pathways for clinical and operational issues.
• Partner with QA and Training teams to support onboarding, refreshers, and targeted coaching.
• Deliver regular performance and staffing reports to operational and clinical leaders.
• Collaborate with Workforce Management, Quality, Training, Recruiting, and Clinical Ops teams.
• Support change management, new program launches, and continuous process improvement.

Healthcare Call Center Supervisor

Bilingual

• Deliver comprehensive virtual care via scheduled and on-demand phone or video visits
• Conduct Annual Wellness Visits and E/M virtual visits
• Perform new patient evaluations and follow-up consultations
• Manage chronic conditions and support remote monitoring
• Assess patient conditions and review medications
• Provide comprehensive consultations and evidence-based care recommendations
• Build strong patient rapport through effective communication
• Accurately document medical records in the EHR system
• Maintain compliance with telehealth and CMS requirements
• Participate in remote training sessions and workflow updates

Bilingual Spanish-Speaking Telehealth Provider, MD/DO/NP

• Manage medically complex patients, develop and monitor care plans across multiple programs
• Complete AWV chart preparation
• Conduct comprehensive nursing assessments addressing physical, functional, psychological, social, environmental, and learning needs
• Communicate patient status and care plan updates to primary care providers and interdisciplinary care teams
• Maintain accurate, timely, and confidential patient records