Specialist III, Enrollment Operations

Tasks

• Build delegated reporting packages
• Conduct pre delegation audits
• Coordinate annual audits
• Ensure compliance with payor standards
• Handle delegated payor communications
• Implement delegated contract agreement processes
• Maintain audit ready credentialing files
• Maintain credentialing committee records
• Maintain delegated compliance
• Manage delegated credentialing lifecycle
• Perform primary source verification
• Prepare quarterly reporting
• Reconcile provider rosters
• Resolve issue resolution requests
• Review delegated contract agreements
• Track NCQA and regulatory changes
• Track adverse actions
• Track corrective action plans

Perks/Benefits

• 401k program
• Commuter benefits
• Dental insurance
• Disability coverage
• Flexible PTO
• Fully remote
• Global travel assistance
• Health insurance
• Home office stipend
• Life insurance
• Meals stipend
• Paid Holidays
• Parental leave
• Pet insurance discounts
• Professional development stipend
• Therapy access
• Vision insurance
• Weekly flexible hours for self care
• Wellness app memberships
• Winter break

Skills/Tech-stack

Action Plans | Action tracking | Adverse Action | Adverse Action Tracking | Corrective Action | Corrective Action Plans | Credentialing Audits | Credentialing Committee Records | Delegated Credentialing | NCQA | Primary Source Verification | Provider Roster Reconciliation | Regulatory Compliance | Source verification