Enrollment Specialist

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OCHIN, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2000

🤝 Non-profit

☁️ SaaS

🤝 B2B

Non-profit • SaaS • B2B

OCHIN, Inc. is a nonprofit health IT consultancy that partners with rural and community care organizations across the United States to advance equitable, whole-person care. For more than 25 years it has provided access to a shared EHR platform and integrated knowledge solutions, and it delivers Health IT, workforce training, operational/financial consulting, research, and advocacy to improve clinical quality, clinician well‑being, and sustainability for its national network of community health providers.

📋 Description

• Perform all aspects of the payor enrollment processes for providers under the OCHIN Collaborative or contracted third parties • Manage credentialing applications, verify credentials, and maintain provider files internally and externally with payor plans • Timely processing of initial credentialing and recredentialing applications in accordance with regulatory requirements (NCQA, HRSA/FTCA, Joint Commission, AAAHC, CMS, or other regulatory standards) • Review and analyze credentialing applications and supporting documents for accuracy and completeness • Validate and verify provider credentials (licensure, DEA, specialty board, certificates, professional liability, and other required documents) through the appropriate verification sources • Identify discrepancies in information, conducting research and follow-up, and escalate unresolved issues • Complete payor provider enrollment process, performing revalidations, maintaining CAQH profiles, NPPES registrations, provider data with payers and managing plan enrollment status in credentialing system • Other duties as assigned

🎯 Requirements

• Minimum of three (3) years of progressive experience in Provider Enrollment, 5+ years preferred • In-depth knowledge of Provider enrollment standards (HRSA, FTCA, TJC, NCQA, etc.) preferred • Certified Provider Credentialing Specialist (CPCS) may be required or strongly preferred (Must be NAMSS not AAPC) • Proficiency in credentialing software and data management systems is preferred • Experience with New York payers preferred • Experience in MD-Staff preferred • Advanced Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, etc.) preferred • Working knowledge of Smartsheet including data structure, formula creation, basic workflows and automation preferred • Proven experience in client-facing roles, with the ability to build strong relationships and communicate effectively with diverse stakeholders preferred • Familiarity with Jira for issue tracking and task management preferred

🏖️ Benefits

• Comprehensive range of benefits • Health insurance • Retirement plans • Paid time off • Flexible working arrangements • Professional development opportunities