deaa6ad2-d184-436b-b69e-17f761da1d94 - Credentialing Operations Specialist

• Submit and track clinician enrollment requests with multiple health plans, following each plan's specific requirements and timelines so clinicians can start seeing members on the correct effective dates. • Build, quality-check, and submit recurring clinician rosters to health plans in Google Sheets and Excel, verifying names, tax IDs, licenses, practice locations, and dates before every submission. • Reconcile roster and enrollment records across internal systems and plan-provided files using advanced spreadsheet techniques (lookups, filters, de-duplication, and multi-tab formulas), resolving discrepancies before they affect claims and payments. • Process clinician requests to add or remove a health plan or a state license, keeping internal records, trackers, and clinician communications accurate from start to finish. • Manage clinician terminations and plan unenrollments so that plan records and internal records reflect the correct end dates. • Monitor enrollment status and turnaround times, and escalate delays and risks with clear context and proposed next steps. • Communicate with clinicians and health plan contacts clearly, promptly, and professionally. • Use AI tools daily for automations/agents, analyzing data, and verifying your work, validating every output before it reaches a health plan or clinician. • Improve and automate roster submission steps using spreadsheet automation and AI, and document procedures so they stay current. • Work with cross functional teams to solve provider inquiries regarding their payer credentialing status or changes to their enrollment. • Support Payer Escalations with timely data on enrollment status and investigations to support the claims team • Update the Alma Portal to match the roster data, working with product to flag and fix errors to avoid claims friction or inaccuracies for provider payer data. • Prepare monthly executive level reports on roster and waitlist accuracy • Health plan rosters are submitted on schedule and accepted with 99%+ accuracy. • Enrollment requests are completed within the agreed turnaround time for each health plan. • Clinician effective dates and plan records are correct, measured through regular audits and fewer claim denials or payment corrections caused by enrollment or roster errors. • Clinician requests to add or remove a plan or state are resolved within the standard response time. • Errors are caught by your own spreadsheet checks and AI-assisted validation before submission, measured by the share of issues found internally rather than by a health plan or Claims. • Written procedures and trackers are current, and at least one repeatable process is simplified or automated with spreadsheets or AI each half-year.