Acts as key point of contact for the processing of enrollment applications for all providers. Works with System Credentialing and local medical staff contacts. Responsible for completing the ongoing review and attestation of all Munson Healthcare provider enrollment records.
Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents.
Prepare and submit credentialing and enrollment packets.
Maintain accurate provider files and track expirations.
Provide assistance to the billing team during staff absences.
Modena Health and Modena Allergy & Asthma are leading medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona and plans for national expansion. They are physician-led and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.
Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Audit internal provider data against database records to ensure 100% accuracy before submission.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.
Ensuring providers are credentialed in a timely manner by monitoring the submission process.
Monitoring submission processes, updating protocols, and managing Virtual Assistants/BPO.
Communicating with payors and conducting regular reviews to validate internal credentialing data.
Grow Therapy aims to be the trusted partner for therapists growing their practice, and patients accessing high-quality care. They are a three-sided marketplace that empowers providers, augments insurance payors, and serves patients and have empowered more than ten thousand therapists.
Manage all aspects of provider licensing, credentialing, and payer enrollment.
Coordinate end-to-end licensing workflows and maintain accurate records.
Act as a key liaison between clinicians, state boards, payers, and internal stakeholders.
They are committed to providing safe, discreet medication abortion treatment and offer a range of reproductive and sexual health care services. The in-house clinical care team composed of board-certified doctors, advanced practice clinicians, nurses, and patient care advocates, is just a text message away.
Provides policy expertise related to systems or products.
Communicates Medicaid program insight to UX researchers and designers.
Analyzes laws and policy documents and explains their impact.
A1M Solutions is a woman-owned small business focused on providing value to customers, employees, partners, and the community, while remaining aligned to its guiding principles. A1M’s mission is to preserve and improve government healthcare programs for underserved people in the United States, focusing on projects with nation-wide impact at the intersection of policy, data, and user experience design.
Navigate the Medicare system for patients and caregivers.
Manage care coordination and logistics, including specialist visits.
Advocate for patients by identifying billing errors and cost-saving programs.
Carewell is dedicated to providing a trusted retail source for caregiving products, offering expert-vetted items like incontinence supplies and mobility aids. They are recognized as one of the fastest-growing companies in the US, committed to improving teams, partnerships, and solutions.
Manages client denials and concerns through analytic review of clinical documentation.
Delivers final determination based on skillsets and partnerships with Humana parties.
Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.
Humana Inc. is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, they strive to make it easier for millions to achieve their best health, delivering needed care and service.
Responsible for economic credentialing and provider enrollment with contracted managed care and governmental plans.
Communicating provider participation information to internal and external customers.
Ensures compliance with regulatory agencies and maintains a working knowledge of statues and laws.
The West Virginia University Health System is West Virginia’s largest health system and the state’s largest employer. They have more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues.
Auditing incoming applications to ensure all required information is documented.
Handling multiple applications simultaneously with using BPM, Cactus, CAQH, and Facets.
Communicating effectively with providers and internal teams to resolve any issues and ensure smooth operations.
BlueCross BlueShield of Tennessee has been helping Tennesseans find their own unique paths to good health since 1945. At BCBST, they empower their employees to thrive both independently and collaboratively, creating a collective impact on the lives of their members.
Support clinical staff by gathering data to complete the medical necessity review process.
Create and send letters to providers and/or members to communicate information.
Collaborate with care management teams and stakeholders to provide optimal service.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, and they’ve built their reputation on over 80 years’ worth of trust. They are motivated by the well-being of their members, putting them first and committing to sustainability and innovation.
Own the end-to-end cycle of credentialing applications for new and existing providers under our contracts, ensuring all requirements are met for successful enrollment.
Assist in building NCQA compliant ongoing monitoring and delegation programs for the Nourish network of RDs.
Support efforts to streamline existing credentialing processes by providing suggestions for automation or new tools, optimizing individual steps, and ensuring smooth workflows.
Nourish is on a mission to improve people’s health by making it easy to eat well. They are building an AI-native, patient-friendly healthcare system centered on nutrition that improves outcomes, lowers costs, and helps people live healthier, longer lives. Nourish launched three years ago, are live in all 50 states, and already have thousands of dietitians and hundreds of thousands of patients on the platform.
Manage fax and mail intake, process medical records requests, and complete insurance pre-authorizations.
Strengthen the operational foundation of our fast-growing digital sleep clinic by handling documentation and correspondence.
Collaborate closely with cross-functional teams in a tech-enabled care environment, contributing to accessible sleep health.
Dreem Health, managed by the Sunrise Group, is America's leading digital sleep clinic that's fixing the broken sleep care patient journey. They connect patients with sleep specialists through a straightforward telehealth platform, eliminating lengthy wait times and complicated in-lab testing.
Own end-to-end E-Verify processing, including collecting required information, setting up accounts, submitting cases, and maintaining accurate records.
Partner with Customer Success Managers to support client-specific data needs, including generating and updating custom reports.
Proactively identify data inconsistencies, compliance risks, or process gaps.
Wrapbook provides a unified payroll platform that seamlessly connects your entire team—production, accounting, cast, and crew—all in one place for film and television production. They are a growing team of 250+ people across the USA and Canada.
Answer a high volume of inbound calls; transfer and direct calls.
Responsible for front office patient coordination; appointment scheduling, transport coordination.
Accurately input data into both Carenet and EMR databases.
Carenet Health pioneers advancements for an experience that touches all points across the healthcare consumer journey. We interact with 1 in 3 Americans every day, delivering positive healthcare experiences and improving outcomes.
Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.
Directly communicate with insurance companies to facilitate the approval of medications.
Navigate pharmacy operating systems to input data and prepare action plans for follow-up.
Communicate directly with patients over the phone to assist them in medication compliance.
Shields Health Solutions provides integrated pharmacy solutions. They partner with hospitals and health systems to improve patient outcomes and create financial value.
Appeal denied claims through Redetermination, Reconsideration, or Administrative Law Judge processes, following laws.
Proactively investigate patient charts by reading documents and conduct computer-based research.
Solventum is a new healthcare company with a history of tackling major challenges to improve lives and support healthcare professionals. They focus on innovative solutions at the intersection of health, material, and data science and are guided by empathy and clinical intelligence.
Lead payer credentialing and re-credentialing processes for healthcare providers.
Ensure compliance with accreditation standards, regulatory requirements, and organizational policies.
Oversee payer enrollments, manage the payer credentialing team, maintain data accuracy, and streamline provider onboarding.
Theoria Medical provides comprehensive medical group and technology solutions to serve patients across the care continuum, with an emphasis on post-acute and primary care. They aim to improve the quality of care delivered, refine facility processes, and enhance critical relationships, serving facilities across the United States.
Be the primary point of contact for all providers.
Provide professional, accurate and timely responses to all provider inquiries.
Maintain a current knowledge of all contract requirements and objectives.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans.