Provider & Payer Services Specialist

About the Role

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.

What You'll Do

• 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

Qualifications

• 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

Preferred

• 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.

Compensation & Benefits

The total target annual compensation range for this position is $55-60,000. The actual compensation offered depends on a variety of factors, which may include, as applicable, the applicant’s qualifications for the position; years of relevant experience; specific and unique skills; level of education attained; certifications or other professional licenses held; other legitimate, non-discriminatory business factors specific to the position; and the geographic location in which the applicant lives and/or from which they will perform the job.

Eleanor Health offers a generous benefits package to full-time employees, which includes:

• 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.