Specialist III, Provider Enrollment Operations
Grow Therapy
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $26 - $30 per hour
About the role
- Ensuring our providers are credentialed in a timely manner by monitoring and maintaining the end-to-end submission process for 10-20 of our payors.
- Monitor our submission processes to make sure that all applications are submitted within SLA. Understand our submission protocols and update them as needed. Manage Virtual Assistants/BPO throughout this process.
- Monitor the follow up process applications, and communicate with the payors directly to ensure that applications are staying on-track.
- Conduct regular reviews to validate the accuracy of our internal credentialing data against the payor’s data to ensure our credentialing data serves as a source of truth across the organization.
- Maintain documentation for each process to ensure smooth operations.
- Work with the Revenue Cycle Management team on any Credentialing related claim denials.
- Assist in building out new payor operations as we onboard new payors.
- Create the Submission Protocol for new payors so that applications can be submitted in a standardized format.
- Work with the payor to understand the best way to follow up on applications, and document the process accordingly.
- Determine the best way to regularly review the accuracy of internal credentialing data whether it be requesting a report from the payor or checking a portal.
- Provide a synthesis of each payor’s credentialing operations to the Manager, Provider Enrollment on an as needed based off the data you’re monitoring in our credentialing system.
- Manage special projects as needed.
Requirements
- Certified Provider Credentialing Specialist (CPCS) with at least two years of experience in Provider Enrollment OR at least four years of experience in Provider Enrollment
- Strong familiarity with credentialing processes, terminology and primary source verification resources; these include: CAQH, NPDB, PECOS, State Licensing, Accreditation and Certification agencies
- Excellent communication skills. You have the ability to be persuasive and credible with a wide variety of audiences both internal and external.
- You know how to hold people accountable. You drive clarity on what’s needed to get something done, and you ensure deadlines are met.
- You’re tech savvy. You’ve efficiently learned new software in the past, and you’re willing to learn HubSpot, Verifiable, Slack, and Excel if you don’t know how to use them already.
Benefits
- Comprehensive Health Coverage: Medical, dental, and vision insurance, plus life and disability coverage.
- Parental Leave & Family Support: Up to 18 weeks paid leave and a new child stipend.
- Financial Wellness: 401(k) program and equity opportunities.
- Meals & Home Office Support: Stipends for home office setup and ongoing funds for meals, with tailored perks for both remote and in-office employees.
- Time Off to Recharge: Flexible PTO, 12 paid holidays, and a full winter break week.
- Wellness & Development: Annual stipends to put towards personal & professional growth.
- Mental & Physical Health Support: No-cost access to therapy through the Grow platform, weekly flexible hours for self-care (“Mental Health Mornings/Afternoons”) and memberships to leading wellness apps (such as One Medical, Headspace, and Talkspace).
- Extra Perks: Pet insurance discounts, commuter benefits, and global travel assistance.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
credentialing processesprimary source verificationsubmission protocolsdata validationclaim denials managementprocess documentationproject management
Soft Skills
communication skillspersuasivenessaccountabilityclarity in task managementdeadline management
Certifications
Certified Provider Credentialing Specialist (CPCS)