Provider Enrollment Specialist Job at Anders Minkler Huber & Helm LLP (St. Louis)

Provider Enrollment Specialist II - HP Enrollment Eligibility

Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care cred...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

High School Diploma
1-3 years of Payer Enrollment experience
Solid knowledge and utilization of PC applications to include WORD, EXCEL, ACCESS
Excellent written and verbal communication skills
Excellent organization and planning skills with demonstrated teamwork skills
Proven ability to interact with all levels of management and other Associates

Job Responsibility

Collects and maintains data on providers for Medicare and Medicaid enrollment
Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates
follows up by telephone or in writing, with carriers regarding application status
Complies with Medicare and Medicaid provider enrollment guidelines
Requests NPI numbers for providers and clinics as necessary and maintains NPI files
Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals
Generates various reports to identify outstanding claims issues with provider numbers and non-payment
Communicates information to appropriate personnel
Educates staff on corrections, e.g.. front-end entry errors in a positive, constructive manner
Collects and reviews managed care contracts for correct billing and payment terms

Fulltime

Outbound Enrollment Specialist

As an Outbound Enrollment Representative, you will be responsible for making out...

Location

United States

Salary:

40000.00 - 50000.00 USD / Year

Pomelo Care

Expiration Date

Until further notice

Requirements

Ability to work Monday-Friday, 8:30am - 5:00pm CT
Strong, empathetic communication skills
Motivated by goals, metrics, and monthly bonus program
Passionate about changing the current landscape of healthcare
Strong organizational and time-management skills
Ability to work independently and as part of a team
Willing to work occasional overtime hours
Are internet-connected, able to work remotely

Job Responsibility

Conduct high volume outbound calls to patients to provide information and education about Pomelo Care services and resources
Achieve member enrollment goals as driven by company KPIs
Support patients by answering their questions, addressing their concerns, and providing guidance on how Pomelo can support their needs
Document all interactions and maintain timely, accurate records of patient outreach activities
Collaborate internally and externally with healthcare providers, community organizations, and other stakeholders to ensure patients receive appropriate care and services
Work with families to schedule appointments and follow-up care as needed
Participate in training and development opportunities to stay current on healthcare trends and regulations
Manage inbound calls from potential patients

What we offer

Competitive healthcare benefits
Generous vacation policy
Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)
Uncapped performance bonus paid out monthly

Fulltime

Bilingual Outbound Enrollment Specialist

As an Outbound Enrollment Representative, you will be responsible for making out...

Location

United States

Salary:

45000.00 - 55000.00 USD / Year

Pomelo Care

Expiration Date

Until further notice

Requirements

Ability to work Monday-Friday, 8:30am - 5:00pm CT
Fluent in Spanish and English
Strong, empathetic communication skills
Motivated by goals, metrics, and monthly bonus program
Passionate about changing the current landscape of healthcare
Strong organizational and time-management skills
Ability to work independently and as part of a team
Willing to work occasional overtime hours
Are internet-connected, able to work remotely

Job Responsibility

Conduct high volume outbound calls to patients to provide information and education about Pomelo Care services and resources
Achieve member enrollment goals as driven by company KPIs
Support patients by answering their questions, addressing their concerns, and providing guidance on how Pomelo can support their needs
Document all interactions and maintain timely, accurate records of patient outreach activities
Collaborate internally and externally with healthcare providers, community organizations, and other stakeholders to ensure patients receive appropriate care and services
Work with families to schedule appointments and follow-up care as needed
Participate in training and development opportunities to stay current on healthcare trends and regulations
Manage inbound calls from potential patients

What we offer

Competitive healthcare benefits
Generous vacation policy
Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)
Uncapped performance bonus paid out monthly

Fulltime

Provider Credentialing Specialist

Work with the New Ventures team to complete health plan credentialing accurately...

Location

United States

Salary:

55000.00 - 75000.00 USD / Year

Pomelo Care

Expiration Date

Until further notice

Requirements

2-4 years of experience in a high volume, credentialing specialist role
Deep expertise with commercial health plan credentialing processes, including health plan portals & CAQH
Highly organized with a strong attention to detail
A proactive and resourceful problem-solver who is comfortable navigating ambiguity and independently seeks out answers and solutions
An accountable and collaborative team player with excellent communication skills, both written and verbal
An expert at prioritization & time management, who proactively shares deliverable timelines and roadblocks

Job Responsibility

Complete group & practitioner health plan credentialing on behalf of Pomelo’s telehealth clinic & care team
Track applications from submission to approval, contracting, and agreement, ensuring cross-functional visibility into key milestones & timelines
Proactively mitigate application delays & denials
Rigorously follow up on any delays and/or denials to right-size
Collaborate with Pomelo licensing, credentialing, and enrollment team to ensure proper clinician licensure & up-to-date CAQH profiles, to help expedite health plan credentialing
Collaborates with care team of nurses, nurse practitioners, doctors, therapists & registered dietitians to support navigation & answer questions about clinician credentialing applications

What we offer

Competitive healthcare benefits
Generous equity compensation
Unlimited vacation
Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)

Client Partner – Credentialing Specialist

Join our team in Manila as a Client Partner - Credentialing Specialist. We are s...

Location

Philippines , Taguig City

Salary:

Not provided

Access Healthcare LLC

Expiration Date

Until further notice

Requirements

Strong knowledge of Payer Processes and Credentialing
Willingness to work continuously in night shifts
Must be fluent in English language
Willing to work in the night shift at our office in McKinley Hill, Taguig
Must have at least 1 year of experience in Credentialing processes for US healthcare customers

Job Responsibility

Manage the end-to-end provider enrollment process, ensuring healthcare providers are properly credentialed and enrolled with insurance networks
Conduct thorough review of provider documentation, ensuring compliance with credentialing requirements and proactively resolving any discrepancies
Serve as a liaison between healthcare providers and insurance companies, addressing enrollment-related inquiries and facilitating timely resolution
Maintain accurate and up-to-date provider information in databases, and collaborate with internal teams to streamline the enrollment and billing processes

New

Payer Delegation and Compliance Specialist

The Payer Delegation and Compliance Specialist at A5 Healthcare serves a critica...

Location

United States , St. Louis; Tulsa

Salary:

68500.00 - 81500.00 USD / Year

Anders Minkler Huber & Helm LLP

Expiration Date

Until further notice

Requirements

Proven leadership ability and experience mentoring or training junior staff
Advanced understanding of CVO credentialing workflows, payer delegation requirements, and NCQA regulatory compliance
High-level organizational and problem-solving skills with keen attention to detail
Excellent written and verbal communication
capable of handling sensitive issues with professionalism
Proficient in credentialing and enrollment systems, with strong Excel and Microsoft Office Suite skills
Self-directed, accountable, and capable of managing priorities in a fast-paced remote environment
Associate’s degree required
Bachelor’s degree in healthcare administration or a related field preferred
Minimum 5 years of experience in delegation and compliance, payer enrollment or healthcare credentialing, including experience with NCQA, URAC, and CMS standards

Job Responsibility

Payer Delegation: NCQA standards (understand and identify changes necessary to comply with NCQA standards)
CAQH Application retrieval and review
File Audit and Analysis for inappropriate documentation and updates to credentialing information
Conduct qualitative analysis of inappropriate documentation and updates
Payer Rosters must be completed in accordance with A5’s policy and procedures
Credentialing Information Integrity
Policy and procedure (writing and updating in accordance with payer and NCQA standards)
Trouble shoot and problem solve implementation challenges related to NCQA standards, policy, and procedures
Evolution of system controls requirements
Team Collaboration: Communicate regularly with the non-delegated provider enrollment and CVO teams

What we offer

Work Flex program which gives you the opportunity to work at our Chesterfield office, our Downtown St. Louis office, remotely, adopt a hybrid approach or even switch between these options as you prefer
Professional development opportunities
Benefits that directly impact mental, physical and financial wellness

Fulltime

Medical Staff Credentialing Specialist and Coordinator

The Medical Staff Credentialing Specialist and Coordinator assists the Medical D...

Location

United States , Medina

Salary:

50000.00 - 60000.00 USD / Year

Orleans Community Health

Expiration Date

Until further notice

Requirements

Associates Degree or Certified Provider Credentialing Specialist (CPCS)
A minimum of 2-3 Years Credentialing experience is preferred
Excellent verbal and written communication skills, ability to relate well with people of diverse backgrounds, training and experience
Proficiency with medical practice software programs, Familiarity with credentialing requirements of hospitals and insurance carriers
Understanding of Malpractice insurance coverages and policies
Knowledge and understanding of credentialing process
Ability to organize and prioritize work and manage multiply priorities
Ability to research and analyze data
Ability to work independently with minimal supervision
Ability to establish and maintain effective working relationships with providers, management, staff and external contacts

Job Responsibility

Compiles and maintains current and accurate data for all providers
Completes provider credentialing and re-credentialing applications, monitors applications and follow-up as needed
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
Maintains corporate provider contract files
Maintains knowledge of current health plan and agency requirements for credentialing providers
Sets up and maintains provider information in online credentialing databases and system
Tracks license and certification expirations for all providers to ensure timely renewals
Ensures practice addresses are current with health plans, agencies and other entities
Audits health plan directories for current and accurate provider information
Completes credentialing/re-credentialing application packets for hospital, insurance carriers and government programs

What we offer

vacation and sick time
health, dental and vision
pension and retirement plan
competitive wages, with superior pension and retirement plans with employer contributions
12% shift differential for working evening and night shifts
excellent vacation, holiday and sick leave package
tuition assistance
free parking

Fulltime

Outreach & Engagement Manager

Managing and motivating teams to drive enrollment. Drive enrollment and activati...

Location

United States

Salary:

90000.00 - 115000.00 USD / Year

Pomelo Care

Expiration Date

Until further notice

Requirements

Earned your Bachelor's degree in healthcare management, public health, or a related field
Able to work some evenings, with a standard schedule of Monday - Friday, 8:30am - 5:00pm CST
Proven experience in healthcare management, specifically in outbound calling and proactive outreach
Strong knowledge of Medicaid policies, procedures, and value-based care
Excellent communication and interpersonal skills to engage with diverse patient populations
Demonstrated leadership abilities, with experience in managing and motivating teams
Proficient in data analysis and reporting, using metrics to drive performance improvements
Detail-oriented, with exceptional organizational and documentation skills
Ability to adapt to changing priorities and work effectively in a fast-paced environment
Familiarity with healthcare software systems and customer relationship management (CRM) tools

Job Responsibility

Lead, and manage a team of outreach specialists providing regular training, and coaching to achieve enrollment KPIs
Facilitate onboarding and training of new specialists
Analyze qualitative and quantitative outreach performance metrics to identify trends and opportunities to improve key KPIs including enrollments and CAC
Monitor call quality and adherence to established protocols and standards by conducting regular audits of call recordings and specialist interactions
Maintain accurate and up-to-date documentation of specialist interactions, outcomes, and follow-up actions, adhering to privacy and confidentiality regulations
Identify opportunities and implement process improvements to enhance the efficiency and effectiveness of outbound and inbound calling
Execute on regular performance evaluations of outreach specialist calls and documentation
Create and maintain team schedules to ensure adequate coverage
Ensure compliance with government regulations and guidelines in all outbound calling and outreach activities
Foster a supportive and inclusive team environment, encouraging professional growth and development

What we offer

Competitive healthcare benefits
Generous equity compensation
Unlimited vacation
Membership in the First Round Network (a curated and confidential community with events, guides, thousands of Q&A questions, and opportunities for 1-1 mentorship)

Fulltime

Provider Enrollment Specialist

Anders Minkler Huber & Helm LLP

Location:
United States , St. Louis

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
January 13, 2026

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