Provider Enrollment & RCM Support Specialist

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:

1. ✅ Your updated resume
2. ✅ A 1–2 minute Loom video introducing yourself and outlining their experience in credentialing or RCM
3. ✅ Work samples such as dashboards, trackers, or process documentation