Provider Enrollment Specialist
- Job Title
- Provider Enrollment Specialist
- Job ID
- 27747578
- Work From Home
- Yes
- Work Remote
- Yes
- Location
- Work From Home Remote
- Other Location
- Description
-
Are you interested in working in enrollment and credentialing for a growing network of providers in the maternal health space? Do you love owning a process end-to-end, organizing information, and problem-solving in a fast-paced, high-impact work environment? Are you driven to change the standard of care in women’s health?
The Lactation Network is hiring a Provider Enrollment Specialist. Reporting to the Provider Enrollment Specialist, this role will partner closely with our consultant relations management and commercial teams to help us meet credentialing and other requirements with our network of IBCLCs. This role is responsible for the accurate and timely submission of provider enrollment applications and ensuring that all providers are credentialed and enrolled with the necessary payers to facilitate smooth billing processes and minimize reimbursement delays.
We are a small, tight-knit, purpose-driven organization with big growth goals in 2025 and beyond. We don’t have all the answers and we don’t expect you to, either. We do expect you to be curious, hardworking, and striving to be your best self.
Breakdown of the role- Provider Enrollment (40%). – You’ll support the enrollment and credentialing process for our expanding network of TLN providers. This includes managing CAQH profiles, monitoring certifications, conducting background checks, and ensuring compliance with the requirements set by our health plan and benefit sponsor partners.
- Credentialing Compliance Monitoring (40%). – You will be responsible for overseeing credential compliance for our TLN provider network. This includes tracking key credentials such as IBCLC certifications, Lactation Consultant licenses, Professional Liability Insurance (PLI) information, and CAQH profiles. You’ll proactively notify providers of upcoming expirations, verify updated credentials, and upload them to their accounts.
- Documentation and Reporting (20%) .– This role will provide ongoing reports on the status of Lactation Consultant credentials to the Provider Enrollment and Credentialing Manager, ensuring accuracy and up-to-date compliance records.
What you’ll do- Prepare, review, and submit provider enrollment applications, re-credentialing applications, and/or rosters to various commercial and government payers.
- Track and monitor the status of applications to ensure timely completion and follow-up as needed.
- Maintain accurate records of enrollment status, effective dates, and any issues that may arise during the process.
- Verify and update provider credentials, including licenses, certifications, malpractice insurance, and other necessary documents.
- Monitor our Lactation Consultant credentials such as IBCLC certifications, PLI Information, CAQH profiles, and notify them of upcoming expiration dates
- Ensure compliance with all payer requirements and standards.
- Serve as a liaison between providers, billing departments, and payers to resolve any enrollment-related issues.
- Communicate effectively with providers to obtain necessary documentation and provide updates on application status.
- Maintain organized and up-to-date provider enrollment files and records.
- Generate reports on enrollment activities, application statuses, and any issues encountered.
- Verify that each provider has a current re-attested CAQH profile and add new providers to our group CAQH portal after initial onboarding.
To perform this job successfully, an individual must be able to satisfactorily perform each essential duty. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.- 2+ years of experience in provider enrollment, credentialing, or a related role within the healthcare industry.
- Knowledge of healthcare provider enrollment processes, including Medicare, Medicaid, and commercial insurance payers.
- Demonstrated ability to effectively perform work and achieve goals in a fast-paced, dynamic work environment
- Demonstrated self-starter; strong skills in taking initiative, organization, standing alone, flexing when needed, and dealing with ambiguity
- Demonstrated exceptional relationship-building and interpersonal skills
- Unlimited PTO. We work hard. We’re passionate about what we’re building together. We also have lives outside work.
- Healthcare benefits. Medical plus voluntary vision, dental. (We are a healthcare company, after all.)
- 401(k) with 4% employer match. We’re planning for the future—and we want to help you do the same.
- Remote-first culture. We are a distributed, remote-first team. We also like spending time together in our Chicago office and have a flexible in-office culture for those who wish to return to work in person.
- Mindfulness and Meditation App. You’ll have complimentary access to the leading app for meditations, sleep stories, and other wellness resources.
- Recharge. We have one designated “no meeting day” each week so you can take a break from videoconferencing and have some quiet time to focus.
- Professional development. We invest in our team by offering every employee access to a professional development budget.
- Competitive compensation. We’re looking for top talent.
- A growth environment. The sky’s the limit.
About The Lactation Network
The Lactation Network is setting a new standard for parents and lactation consultants alike. At TLN, our movement goes beyond any single outlet or tool. We activate education, connection, and advocacy to foster the new network of inclusive care between parents and IBCLCs; the network where every caregiver has the resources to thrive. TLN is powered by the largest network of IBCLCs in the country. Together, we are here to make sure families get the expert insurance covered lactation care that they deserve.
The Lactation Network is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
