Enrollment Specialist

Job Type

Full-time

Description

MAKE A DIFFERENCE AT OCHIN

OCHIN is a nonprofit leader in health care innovation and a trusted partner to a growing national provider network, delivering the clinical insights and tailored technologies needed to expand patient access, strengthen care teams, and improve the health of rural and medically underserved communities.

We are hiring for a number of new positions to meet increasing demand. When you choose to join OCHIN, you have the opportunity to continuously grow your skills and do meaningful work to help fulfill our vision of good health and well-being for everyone.

At OCHIN, we value the unique perspectives and experiences of every individual and work hard to maintain a culture rooted in our values.

Founded in Oregon in 2000, OCHIN employs a growing virtual workforce of more than 1,200 skilled professionals, working remotely across 49 states. We offer a generous compensation package and are committed to supporting our employees' entire well-being by fostering a healthy work-life balance and opportunity for professional advancement. We are curious, collaborative learners who strive to live our values every day.

OCHIN is excited to support our continued national expansion and the increasing demand for our innovative tools and services by welcoming new talent to our growing team.

Position Overview:

The Enrollment Specialist performs all aspects of the payor enrollment processes for providers under the OCHIN Collaborative or contracted third parties. The Business Partner - Enrollment Specialist will manage credentialing applications, verify credentials, and maintain provider files internally and externally with payor plans. This position is part of the credentialing team; however, the primary responsibilities will be enrollment.

Essential Functions:

• Timely processing of initial credentialing and recredentialing applications in accordance with regulatory requirements (NCQA, HRSA/FTCA, Joint Commission, AAAHC, CMS, or other regulatory standards).
• Reviewing and analyzing credentialing applications and supporting documents for accuracy and completeness.
• Validating and verifying provider credentials (licensure, DEA, specialty board, certificates, professional liability, and other required documents) through the appropriate verification sources.
• Identifying discrepancies in information, conducting research and follow-up, and escalating unresolved issues.
• Completing 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.
• Prior to moving forward to the team interview, all candidates are required to complete a 50-60-minute competency assessment. The assessment gives us insights into how your strengths, preferences, and work style align with the OCHIN's nine core competencies. It's not about passing or failing-it's about understanding fit and setting you up for success.

Base Pay Overview

OCHIN uses broadened pay ranges to support equitable and market-aligned compensation practices. The final offer will be based on a variety of factors, including relevant skills, certifications, education, experience, training, responsibilities, internal equity, and market data.

Physical Requirements/Work Environment:

• Constant interpersonal skills, teamwork, and customer service. Frequent creativity, mentoring, presentations, and teaching. Occasional decision making and independent judgment or action.
• Reading, speaking, writing, and understanding English.
• While performing the duties of the job, the employee is regularly required to sit for long periods of time; stand and walk; use hands to finger, handle or feel; reach with hands and arms.
• This position requires a virtual home-office environment, working remotely.
• The role routinely uses standard office equipment such as computers and mobile devices.
• Travel is required to support OCHIN's business requirements for Go-Live installations or training which may require travel by air, vehicle, or train.

Work Location and Travel…