Talent.com
Healthcare Operations Specialist (Provider Enrollment & RCM)

Healthcare Operations Specialist (Provider Enrollment & RCM)

Hire OverseasAR
Hace 1 día
Tipo de contrato
  • Teletrabajo
  • Quick Apply
Descripción del trabajo

We’re looking for a detail-oriented and process-driven Healthcare Operations Specialist to support our provider enrollment and revenue cycle operations as the company expands into new states.

This role is ideal for someone who thrives on accuracy, structure, and proactive problem-solving —ensuring providers are credentialed on time, payer workflows are clean and compliant, and no claims fall through the cracks. You’ll play a critical role in bridging credentialing, billing, and payer management to help keep operations running seamlessly.

🎁 Perks & Benefits

  • 💵 Paid in USD every 15th & 30th of the month
  • 🌴 Up to 14 days of Paid Time Off annually (starting Day 1)
  • 📅 Observance of Holidays (based on your location)
  • 🏡 100% remote – work from anywhere
  • 🌍 Be part of meaningful, high-impact healthcare operations projects
  • 🚀 Work with a fast-moving, collaborative team where your input drives real results

🧩 What You’ll Be Doing

🩺 Provider Enrollment & Credentialing

  • Manage the end-to-end provider credentialing process , from initial submission to approval, across multiple states and payers.
  • Research payer-specific requirements and maintain up-to-date documentation for all enrollments.
  • Track credentialing statuses, expirations, and revalidations through a live credentialing tracker for full visibility.
  • Coordinate both group and individual provider enrollments , ensuring compliance and timely activation.
  • Forecast provider go-live timelines and communicate proactively with internal teams to align scheduling and billing readiness.
  • Identify and resolve enrollment issues with payers, escalating as needed to minimize delays.
  • Develop and maintain credentialing playbooks to standardize processes and support scalability.
  • 💰 Revenue Cycle Management (RCM)

  • Support end-to-end payer workflows , including Verification of Benefits (VOB), prior authorizations, and fee schedule setup .
  • Audit payer setup in the system to ensure data accuracy for clean claim submission.
  • Collaborate with billing teams to resolve issues that impact claim processing or reimbursement .
  • Conduct payer research —including eligibility, coverage limits, submission processes, and reimbursement policies—to reduce denials.
  • Track and support copay and coinsurance collection , including payment plan documentation and reporting.
  • Ensure full compliance with CMS billing standards, NCQA guidelines, and payer credentialing requirements.
  • Stay informed on Medicaid and commercial payer policy updates and communicate key changes to internal teams.
  • 📞 Cross-Functional Communication

  • Act as the point of contact for payers, providers, and internal teams , ensuring timely and clear communication.
  • Provide updates on credentialing and RCM statuses to leadership and key stakeholders.
  • Help document and improve operational workflows for better efficiency and accuracy.
  • ✅ Who You Are

  • 5+ years of experience in healthcare operations, provider enrollment, credentialing, or RCM .
  • Deep understanding of how credentialing impacts billing and revenue cycles.
  • Organized, analytical, and highly detail-oriented with excellent follow-through.
  • Skilled in using tools like CAQH, Availity, or payer portals for credentialing and RCM management.
  • Strong communicator who can collaborate effectively across departments and with external partners.
  • Comfortable with multi-state operations, payer variations, and regulatory compliance .
  • Adaptable and proactive—able to manage multiple priorities and adjust quickly as processes evolve.
  • Bonus Points

  • Experience working with Medicaid, Medicare, and commercial payer networks .
  • Background in ABA, behavioral health, or multi-specialty provider credentialing.
  • Knowledge of claims auditing, denial management, or in-house RCM transitions.
  • 🎯 Success Metrics

  • Zero provider idle time due to credentialing or enrollment delays.
  • 100% payer workflows completed accurately and on time.
  • Reduced claim denials through proactive payer setup and process audits.
  • Consistent regulatory compliance across all payer and provider types.
  • Improved revenue flow through alignment between credentialing and billing functions.
  • 📩 How to Apply

    Please submit :

  • ✅ Your updated resume
  • 🎥 A 1–2 minute Loom video introducing yourself and describing your experience with provider enrollment and RCM processes.
  • 🧾 (Optional) Examples of trackers, checklists, or process documentation you’ve built or managed.
  • Only candidates who submit a Loom video will be moved to the next step of the hiring process.

    🧠 If you’re a healthcare operations expert who understands how credentialing and billing power great patient care—we’d love to hear from you.

    📋  Application Process Overview

    Our comprehensive selection process ensures we find the right fit for both you and our clients :

  • Initial Application  - Submit your application and complete our prequalifying questions
  • Video Introduction  - Record a brief video introduction to showcase your communication skills and work experience
  • Role-Specific Assessment  - Complete a homework assignment tailored to the position (if applicable)
  • Recruitment Interview  - Initial screening with our talent team
  • Executive Interview  - Meet with senior leadership to discuss role alignment
  • Client Interview  - Final interview with the client team you'd be supporting
  • Job Offer  - Successful candidates receive a formal offer to join the team
  • Each stage is designed to evaluate your fit for the role while giving you insights into our company culture and expectations. We'll keep you informed throughout the process and provide feedback at each step.

    Crear una alerta de empleo para esta búsqueda

    Specialist • AR

    Ofertas relacionadas
    • Oferta promocionada
    Anesthesiologist Recruiter

    Anesthesiologist Recruiter

    Korn Ferry, , Argentina, Argentina
    We unlock the potential in your people and unleash transformation across your business - synchronizing strategy, operations, and talent to accelerate performance, fuel growth, and inspire a legacy ...Mostrar másÚltima actualización: hace 1 día
    Argentina, Hematology / Oncology Account Manager

    Argentina, Hematology / Oncology Account Manager

    Massive Bio, Inc.AR
    Quick Apply
    Argentina, Hematology / Oncology Account Manager Massive Bio is a rapidly growing health-tech startup founded in 2015 to provide every cancer patient with access to clinical trials regardless o...Mostrar másÚltima actualización: hace más de 30 días
    Talent Acquisition & Engagement Specialist (Remote) - HR Department

    Talent Acquisition & Engagement Specialist (Remote) - HR Department

    Uptalent.ioAR
    Teletrabajo
    Quick Apply
    Talent Acquisition & Engagement Specialist (Remote) - HR Department.LATAM talent with high‑growth companies worldwide.We move at startup speed, delivering curated shortlists of engineers, archi...Mostrar másÚltima actualización: hace más de 30 días
    Resolution Specialist

    Resolution Specialist

    Bulldog AdjustersAR
    Teletrabajo
    Quick Apply
    The Resolution Specialist is responsible for reviewing, preparing, and submitting supplements to insurance carriers on behalf of Bulldog Adjusters. This role focuses on addressing discrepancies betw...Mostrar másÚltima actualización: hace 22 días
    • Nueva oferta
    Healthcare Copywriter

    Healthcare Copywriter

    Hire OverseasAR
    Teletrabajo
    Quick Apply
    You’ll help rewrite and refresh core website pages, product and service descriptions, and category content as we prepare for a major site relaunch. You’ll collaborate with marketing and product team...Mostrar másÚltima actualización: hace 11 horas
    Patient Care Coordinator (US-based Health Clinic)

    Patient Care Coordinator (US-based Health Clinic)

    PearlAR
    Teletrabajo
    Quick Apply
    Independent Contractor, Full-time.Monday–Friday, ideally with consistent morning coverage (EST / PST preferred); flexible for the right candidate. Monday to Friday priority.Remote, open to candidates...Mostrar másÚltima actualización: hace 5 días
    Site Engagement Liaison

    Site Engagement Liaison

    ICONRemote, Argentina
    Manages and prioritizes the clinical deliverables to ensure that deliverables meet quality and regulatory requirements, project timelines, budget, and sponsor expectations.Creates and administers c...Mostrar másÚltima actualización: hace más de 30 días
    Site Engagement Liasion

    Site Engagement Liasion

    ICONRemote, Argentina
    ICON plc is a world-leading healthcare intelligence and clinical research organization.We’re proud to foster an inclusive environment driving innovation and excellence, and we welcome you to join u...Mostrar másÚltima actualización: hace 6 días
    Influencer & Partner Manager for a Wellness company (US Based / Remote)

    Influencer & Partner Manager for a Wellness company (US Based / Remote)

    PairedAR
    Teletrabajo
    Quick Apply
    Paired is a global staffing and recruiting agency that pairs remote work with top-tier talent.We admire the importance of innovative social media strategies and are committed to connecting talented...Mostrar másÚltima actualización: hace más de 30 días
    Medical Operations Officer

    Medical Operations Officer

    Maritime & Healthcare GroupArgentina, AR
    Quick Apply
    MHG is a globally recognized and MLC and ISO certified provider of comprehensive medical solutions for the maritime industry. Since 2019, we have focused on supporting vessels with a range of servic...Mostrar másÚltima actualización: hace más de 30 días
    Client Operations Representative

    Client Operations Representative

    CrewBloomAR
    Teletrabajo
    Quick Apply
    We are seeking a highly organized, proactive, and detail-oriented.Client Operations Representative (COR).In this role, you will support our Client Results team, ensuring the seamless delivery of cl...Mostrar másÚltima actualización: hace 28 días
    Contracting Specialist

    Contracting Specialist

    Prove PartnersAR
    Quick Apply
    Contracting Specialist About Us : • PROVE Partners, LLC, founded in 2003 and is based in Las Vegas Nevada.PROVE is primarily engaged in a fast-growing form of specialty reimbursement commonly r...Mostrar másÚltima actualización: hace más de 30 días
    Amazon Catalog & Optimization Specialist

    Amazon Catalog & Optimization Specialist

    Activate TalentAR
    Teletrabajo
    Quick Apply
    Full-Time | Remote || 9 : 00 AM – 5 : 00 PM EST (semi-flexible, Hubstaff required).Our client is a fast-growing beau...Mostrar másÚltima actualización: hace más de 30 días
    Contracting Support Specialist

    Contracting Support Specialist

    Prove PartnersAR
    Quick Apply
    Contracting Support Specialist About Us : • PROVE Partners, LLC, founded in 2003 and is based in Las Vegas Nevada.PROVE is primarily engaged in a fast-growing form of specialty reimbursement co...Mostrar másÚltima actualización: hace más de 30 días
    Remote Business Development Specialist – Clinical Trials (Part-Time / Full-Time)

    Remote Business Development Specialist – Clinical Trials (Part-Time / Full-Time)

    Angel City VAAR
    Quick Apply
    Now Hiring : Remote Business Development Specialist – Clinical Trials (Part-Time / Full-Time) 📢 Are you a results-driven professional with a passion for healthcare and sales?.Join ...Mostrar másÚltima actualización: hace más de 30 días
    Clinical Trial Manager II

    Clinical Trial Manager II

    ICONRemote, Argentina
    Primary point of contact to lead, manage and co-ordinate the conduct of clinical trials from study start-up (COLA) to close out at a country level in accordance with ICH-GCP and other applicable lo...Mostrar másÚltima actualización: hace más de 30 días
    SMA I

    SMA I

    ICONRemote, Argentina
    ICON plc is a world-leading healthcare intelligence and clinical research organization.We’re proud to foster an inclusive environment driving innovation and excellence, and we welcome you to join u...Mostrar másÚltima actualización: hace 6 días
    Engagement Lead

    Engagement Lead

    ImprovadoAR
    Quick Apply
    Improvado is an AI-powered, unified platform designed for marketing teams in medium to large-scale enterprises and agencies, who are looking to automate complex marketing intelligence and rep...Mostrar másÚltima actualización: hace más de 30 días