Senior Enrollment Representative

Job Description

REQUIREMENTS

• High School Diploma/GED
• 4+ years of healthcare provider enrollment experience
• 2+ years of experience working with compliance workflows and processes, including NCQA policies and practices
• 2+ years of experience researching and applying payer and government regulatory requirements
• Intermediate level of proficiency with MS Excel and Word

Preferred :

• Demonstrated experience managing payer rosters and complex enrollment workflows
• Experience working with MD-Staff (or similar credentialing/enrollment systems)
• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

RESPONSIBILITES

• Manage end-to-end provider enrollment workflows, including roster submissions, individual enrollments, and revalidations across multiple payers
• Maintain and update provider data across systems including MD-Staff, roster templates, and payer platforms, ensuring consistency and accuracy
• Proactively track and follow up on enrollment statuses, resolving delays and preventing gaps that impact billing or network participation
• Serve as a subject matter expert on payer-specific requirements, identifying nuances and adapting processes accordingly
• Partner closely with RCM to investigate and resolve claim denials, reimbursement delays, and enrollment-related billing issues
• Conduct audits, identify root causes of errors, and support process improvements to enhance accuracy and efficiency
• Manage high-volume workloads and competing priorities, ensuring deadlines are consistently met without sacrificing quality
• Operate effectively in an evolving environment where processes and job aids change; demonstrate the ability to bring structure and clarity
• Act as a go-to resource for complex work while supporting overall team performance and success
• Take ownership of issues from identification through resolution, including cross-functional coordination when needed
• Support process improvement efforts by contributing to projects and helping refine existing workflows and team processes
• Extensive work experience, often across multiple functions (Enrollment, Credentialing, RCM)
• Work frequently requires navigating ambiguity and developing new or improved procedures
• Works independently with a high degree of accountability
• Mentors others and acts as a subject matter expert
• Coordinates activities across teams and functions
• Drives process improvements and operational efficiency

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