Senior Enrollment Representative

About the role

Caring. Connecting. Growing together.

Optum is a global organization dedicated to improving health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Our people are committed to making a meaningful difference in the lives of those we serve.

Responsibilities

• 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

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

Qualifications

• Extensive work experience, often across multiple functions (Enrollment, Credentialing, RCM)
• Works 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

Skills

• Strong communication and interpersonal skills
• Ability to work independently and manage multiple tasks simultaneously
• Proficiency with MS Excel and Word
• Knowledge of payer and government regulatory requirements

Benefits

Learn more about our range of benefits designed to help you live well.

Pay

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Schedule

FT, 40 hours. Monday - Friday, 7AM - 5PM, flexible time zone.

Location

Remote - Nationwide

Benefits

Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well.