• Responsible for coordinating requests for participation in health insurance network as a medical provider • Monitoring and maintaining provider enrollment and re-enrollment process in a timely and compliant manner • Reviewing provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements • Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner • Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others • Maintains positive working relationships with providers • Plays an active role in explaining providers and practice/office managers the submission requirements for credentialing/recredentialing processes • Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc. • Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data • Proactively obtains updated provider credentialing data prior to expiration • Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions • Completes all additions, updates, and deletions • Supports new provider onboarding processes as related to enrollment • Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner • Fosters working relationships and teamwork with departments, vendors, etc. • Develops databases and spreadsheets for tracking organization providers • Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management • Continuously searches for process improvements to achieve accuracy and efficiencies • Performs other duties as assigned or required

• Conduct prospective, concurrent, and retrospective utilization reviews to assess medical necessity, treatment appropriateness, and level of care • Apply evidence-based UM criteria to evaluate clinical documentation and support authorization and appeal processes • Monitor care intensity and utilization trends to identify outliers and inform targeted provider interventions • Partner with health plans on external UR requests and peer-to-peer review coordination • Investigate and remediate provider concerns stemming from UM findings, client complaints, or external reports • Monitor clinical adverse events and apply early-stage risk mitigation in partnership with cross-functional teams • Support measurement-based care initiatives and identify opportunities to strengthen clinical outcomes across the provider network • Track utilization metrics, review volumes, and case outcomes to inform quality improvement efforts • Surface trends and process gaps to leadership and contribute to the ongoing refinement of UM policies and workflows

• Work with technical teen co-founders and professional developers to build Hideouts • Develop updates, improvements, and new features for mobile and web versions of Hideouts • Collaborate with a team of other interns

• assist with day-to-day administrative tasks needed to keep Hideouts running • work closely with teen co-founders on non-technical, clerical tasks • help with recruitment, various paperwork, and general coordination of company personnel • apply for grants or handling email correspondence with partners