Provider & Payer Services Specialist at Eleanor Health
United States
$55k - $60k
<meta><p style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:8pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;"><b><strong style="font-size:15pt;white-space:pre-wrap;">About the Role</strong></b></p><p style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;"><span style="color:rgb(0,0,0);background-color:rgb(255,255,255);font-size:10pt;white-space:pre-wrap;">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.</span></p><p style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:8pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;"><b><strong style="font-size:15pt;white-space:pre-wrap;">What You'll Do</strong></b></p><ul data-pattern="discCircleSquare" data-depth="1" style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:11pt;font-weight:400;margin:8px 0px;line-height:1.6;padding:0px 0px 0px 32px;list-style-type:disc;"><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Act as the subject matter expert (SME) for provider credentialing/accreditation/insurance regulations, policies, guidelines, and standards.</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">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</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">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</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Address and resolve provider inquiries and concerns related to credentialing and/or enrollment in a timely manner</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Facilitate communication between providers and the vendor to ensure all parties have the information needed for efficient operations and a seamless process</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">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</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Assist the contracting department with the initial payer application process and provide information and rosters as requested</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Review, and update if necessary, health plan directories, agencies, and other appropriate entities for current and accurate provider information</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Stay up-to-date with industry regulations and requirements, ensuring compliance at all times</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Assist in preparing for and participating in audits and regulatory reviews</span></li></ul><p style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:8pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;"><b><strong style="font-size:15pt;white-space:pre-wrap;">Qualifications</strong></b></p><ul data-pattern="discCircleSquare" data-depth="1" style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:11pt;font-weight:400;margin:8px 0px;line-height:1.6;padding:0px 0px 0px 32px;list-style-type:disc;"><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">1-3 years of experience in healthcare</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Excellent communication, relationship management, and problem-solving skills</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Knowledge of relevant federal and state regulations</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Knowledge of CAQH, NPPES, PECOS, and payer credentialing portals</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Strong knowledge of industry regulations, such as the National Committee for Quality Assurance (NCQA) and The Joint Commission (TJC) standards</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">An analytic mindset - interested in root cause analysis and process improvement with the ability to work with and manipulate large amounts of data</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Solid background of developing informative and clear training/documentation materials</span></li></ul><p style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:5pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px 0px 0px 40px;"><b><strong style="font-size:12pt;white-space:pre-wrap;">Preferred</strong></b></p><ul data-pattern="discCircleSquare" data-depth="1" style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:11pt;font-weight:400;margin:8px 0px;line-height:1.6;padding:0px 0px 0px 32px;list-style-type:disc;"><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Prior startup experience preferred</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Medallion experience</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Intellectual curiosity and creativity coexisting alongside critical thinking</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">An expert at building and maintaining meaningful relationships, establishing credibility, and thinking strategically.</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Ability to work both independently and collaboratively with internal teams</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Detail oriented, committed to excellence and precision</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Outstanding written and oral communication and presentation skills</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Collaborative and team-oriented mindset to work effectively with cross-functional teams.</span></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Adaptability and ability to thrive in a dynamic environment.</span></li></ul><p style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:15pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;"><b><strong style="color:rgb(0,0,0);font-size:15pt;white-space:pre-wrap;">Compensation & Benefits</strong></b></p><p style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">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.</span></p><p style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:11pt;font-weight:400;line-height:1.6;letter-spacing:0.25px;margin:4px 0px;padding:0px;"><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Eleanor Health offers a generous benefits package to full-time employees, which includes:</span></p><ul data-pattern="discCircleSquare" data-depth="1" style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:11pt;font-weight:400;margin:8px 0px;line-height:1.6;padding:0px 0px 0px 32px;list-style-type:disc;"><li style="color:rgb(0,0,0);font-size:11pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Generous Paid Time Off (prorated for new employees)</strong></b><i><b><strong style="color:rgb(0,0,0);font-size:10pt;font-style:italic;white-space:pre-wrap;"> - </strong></b></i><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">unplug, relax, and recharge! </em></i></li><li style="font-size:11pt;list-style:none;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><ul data-pattern="discCircleSquare" data-depth="2" style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:11pt;font-weight:400;margin-left:0px;margin-right:0px;line-height:1.6;padding:0px 0px 0px 32px;list-style-type:circle;"><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">12 Vacation days</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">12 Wellness (Sick) days</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">3 Floating holidays</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">9 Company-observed holidays</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Jury Duty, Voting Leave, and other forms of paid time off may be available</em></i></li></ul></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Eleanor-paid medical and dental insurance plans, with affordable vision coverage -</strong></b><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;"> </span><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">We are a health first company, and we strive to make our plans affordable and accessible.</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">401(k) plan with 3% match - </strong></b><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">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.</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Short-term disability -</strong></b><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;"> We understand that things happen, we want you to feel comfortable to take time to get better.</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Long Term Disability</strong></b><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;"> - Picks up where Short Term Disability leaves off (employee paid).</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Life Insurance</strong></b><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;"> - Both Eleanor and employee-paid options are available.</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Family Medical Leave -</strong></b><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;"> </span><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">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.</em></i></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Wellness Perks & Benefits -</strong></b><span style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;"> </span><i><em style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">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</em></i></li><li style="font-size:11pt;list-style:none;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><ul data-pattern="discCircleSquare" data-depth="2" style="font-family:"Basel Grotesk",Arial,sans-serif;font-size:11pt;font-weight:400;margin-left:0px;margin-right:0px;line-height:1.6;padding:0px 0px 0px 32px;list-style-type:circle;"><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Mindfulness App Reimbursement</strong></b></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">EAP with eight face-to-face sessions</strong></b></li><li style="color:rgb(0,0,0);font-size:10pt;margin:3px 0px;letter-spacing:0.25px;line-height:1.6;"><b><strong style="color:rgb(0,0,0);font-size:10pt;white-space:pre-wrap;">Virtual health and wellness visits covered by our medical plan. </strong></b></li></ul></li></ul>
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