Credentialing & Payor Enrollment Specialist

Thank you for considering a career at Ensemble!

Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

O.N.E Purpose:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

• Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

• Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:

­­­­­­­­­­­­CAREER OPPORTUNITY OFFERING:

• Bonus Incentives

• Paid Certifications

• Tuition Reimbursement

• Comprehensive Benefits

• Career Advancement

• This position pays between $19.75-$23.50 per hour based on experience

**This role is remote, however, may require travel.

The Credentialing & Enrollment Specialist supports credentialing and enrollment processes to ensure all strategic partner providers are enrolled with insurance payors timely and efficiently. This role has high impact on revenue cycle and positive provider and payor relationships

Essential Job Functions:

• Updates and maintains CAQH profiles to ensure data is accurate, attestations are current and do not expire.

• Maintains accurate provider records and makes edits to provider profiles. Enters new providers and updates data, as needed.

• Manages time-sensitive credentials and takes a proactive approach to license renewals and annual provider or location updates.

• Enters tracking and conducts timely follow-up, staying focused on completion of provider onboarding activities, staying apprised of provider candidates’ statuses and alignment of tasks/goals as an individual and a team

• Supports strategic partners and internal counterparts to answer inquiries and provides enrollment and credentialing updates. Serves as subject-matter-expert for providers with onboarding instructions and support.

• Collaborates with various revenue cycle departments to obtain innovative initiatives to achieve optimal results.

• Develops relationships to achieve quality goals, implement best practices and redesign systems and processes

• Identifies gaps in client support/performance and proposes solutions (e.g. technology, services) to drive performance improvement.

• Works collaboratively with team members to address new issues as they arise and responds promptly with acknowledgement or status

• Proficient use of various HIS and Enrollment Software.

• Enters provider applications into payer portals for enrollment. Demonstrates proficiency in the use of databases, CAQH, NPPES, Licensing Boards, and payer Web sites that will be used daily. Verifies data for accuracy and completeness

• Responds to insurance payers’ requests for information in a prompt and professional manner

• Works as a team with outside vendors and facilities who share the goal of enrolling our providers

• Maintains confidentiality with providers’ personal information and upholds respect for privacy and regulatory requirements. Provides excellent customer service.

• Escalates to Credentialing and Enrollments leadership any issues that require resolution beyond the Credentialing & Enrollment Specialist’s scope of responsibility and alerts leadership to any potential risk regarding meeting deadlines, set standards or goals in place.

This is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Job Experience:

• 1 to 3 Years

• This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Education Level:

• High School Diploma, GED, or Equivalent Experience

Preferred Knowledge, Skills and Abilities:

• Knowledge and understanding of Provider Enrollment, Chain, and Ownership System (PECOS)

• Knowledge and understanding of State Medicaid Portals

• Experience working with insurance enrollments, strongly preferred.

• Intermediate proficiency level in Excel

• High level of attention to detail with the ability to solve problems and function independently

• Prioritize and meet deadlines on an ongoing basis to ensure timely completion according to process requirements

• Strong verbal and written communication skills

• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.

Join an award-winning company

Five-time winner of “Best in KLAS” 2020-2022, 2024-2025

Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024

22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024

Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024

Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023

Energage Top Workplaces USA 2022-2024

Fortune Media Best Workplaces in Healthcare 2024

Monster Top Workplace for Remote Work 2024

Great Place to Work certified 2023-2024

• Innovation

• Work-Life Flexibility

• Leadership

• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits –  We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs. 

• Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.  

• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement. 

• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company. 

Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws.  Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.

This posting addresses state specific requirements to provide pay transparency.  Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position.  A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.

Employment Disclaimers – Ensemble