Provider Enrollment & RCM Support Specialist at Hire Overseas

, , Mexico -

Full Time

Start Date

Immediate

Expiry Date

05 Jan, 26

Salary

0.0

Posted On

07 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing, Revenue Cycle Management, Healthcare Operations, Problem-Solving, Compliance, Documentation, Communication, Organization, Adaptability, Payer Research, Quality Assurance, Regulatory Monitoring, Data Management, Team Collaboration, Process Improvement, Dashboard Management

Industry

Online Audio and Video Media

Description

Our client is looking for a detail-oriented, process-driven Provider Enrollment & RCM Support who can manage the end-to-end credentialing and revenue cycle processes as the company expands into new states. This role is ideal for someone who thrives on structure, accuracy, and proactive problem-solving — ensuring no provider sits idle and every payer workflow runs seamlessly. 🎁 Perks & Benefits 💵 Get paid in USD every 15th & 30th of the month 🌴 Up to 14 days paid time off annually, from day 1 📅 Observance of paid Philippine Regular Holidays (Flexibility of Holidays depending on place of residency) 🏡 100% remote – work from anywhere 🌍 Be part of meaningful, high-impact international projects 🚀 Work with a fast-moving team where your ideas matter 🧩 What You’ll Do 🩺 Credentialing & Enrollment Own end-to-end credentialing as they expand into new states. Research payer requirements per state, prepare submission packets, manage deadlines, and proactively escalate blockers. Build state-specific credentialing playbooks so the process is repeatable. Manage both group credentialing and individual provider credentialing. Coordinate initial group enrollment with each payer and then onboard each BCBA/RBT under that umbrella. Track expirations, revalidations, and renewals so credentials never lapse. Build and maintain a credentialing tracker with status, payer timelines, and blockers. Keep a live dashboard that shows exactly where each provider/state stands. Ensure no provider sits idle due to credentialing delays. Forecast provider go-live dates and align them with state approvals, and promptly notify providers when they’re approved and in-network. Where delays are likely, propose temporary solutions (e.g., assigning to a different payer panel, using single-case agreements) so every provider starts as soon as possible. 💰 Revenue Cycle Management (RCM) End-to-end ownership: Manage the full payer workflow - Verification of Benefits (VOB) → Authorizations → Fee Schedule setup → Payer integration in the platform - ensuring data is accurate, current, and complete. Audit for completeness: Regularly check that payer details are correctly configured on the platform (or Monday). New payer onboarding: When we add new payers, proactively ensure the entire workflow is followed all the way through and the payer properly set up. Copay/Coinsurance: Support copay/coinsurance collection, implement payment plan tracking for copy/coinsurance families. Payer Research: Investigate and document each insurer’s requirements - eligibility checks, coverage limits, claim submission processes, reimbursement policies. Summarize findings into clear, practical references for the team to reduce denials and speed credentialing. Compliance & Quality Assurance: Ensure every action in credentialing, billing, and support adheres to payer rules and industry standards (e.g., CMS billing, NCQA guidelines, delegated credentialing). Develop simple checklists and spot-audits to keep processes clean, compliant, and trusted. Support their plan to transition RCM in-house. Adaptive Responsibilities: Take on evolving ops/RCM projects as Tellos grows - tightening payer workflows, fixing billing leaks, or stepping in on short-term gaps. Stay agile as payer rules shift, ensuring no cracks in process execution. Regulatory Monitoring: Stay ahead of Medicaid and government payer rule changes by actively tracking updates, bulletins, and policy revisions. Build a simple alert system so we catch shifts before they impact claims. ✅ Who You Are At least 5 years of experience in Revenue Cycle Management (RCM) within the healthcare industry. Proven experience in healthcare operations, provider credentialing, or revenue cycle management. Highly organized and proactive, with strong ownership of end-to-end processes. Excellent at maintaining trackers, dashboards, and documentation for visibility and accountability. Detail-obsessed and capable of catching compliance gaps or delays before they become problems. Comfortable working cross-functionally with internal teams and external payers. Adaptable — able to pivot quickly as payer rules or company needs evolve. Strong communicator with excellent written and spoken English skills. 🎯 Success Metrics Zero provider idle time due to credentialing or enrollment delays. 100% payer workflows completed on time and accurately. Reduced claim denials through proactive payer research and compliance audits. Up-to-date regulatory compliance across all states and payer types. Smooth transition of RCM processes in-house. 📩 How to Apply Please submit: ✅ Your updated resume ✅ A 1–2 minute Loom video introducing yourself and outlining their experience in credentialing or RCM ✅ Work samples such as dashboards, trackers, or process documentation

Responsibilities

Manage the end-to-end credentialing and revenue cycle processes as the company expands into new states. Ensure no provider sits idle and every payer workflow runs seamlessly.