Full-Time Associate Director, Payer Enrollment

Associate Director, Payer Enrollment is responsible for facilitating the enrollment program and serves as the primary enrollment liaison for clinics, payers, billing office, and practitioner related issues.

Primary Job Duties:

1. Ensure protocols are being followed to ensure timely resolution and completion of payor enrollment to ensure no loss of revenue due to untimely payor enrollment
2. Assures compliance with all health plan requirements as related to the provider certification and credentialing.
3. Reviews and streamlines processes and workflows for the on-boarding department, using automation, where appropriate
4. Works with both internal and external stakeholders to provide regular updates and resolve complex provider enrollment status and/ or issues, including resolving claim denials related to provider enrollment
5. Works with technical staff to develop tools and procedures for auditing and reporting with the goal of streamlining credentialing processes and communicating with company and external stakeholders
6. Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements
7. Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
8. Maintain up-to-date data for each provider in credentialing databases and online systems; ensure timely renewal of licenses and certifications. Maintains confidentiality of provider information.
9. Mentor and train new and existing staff.
10. Autonomously lead meetings with key internal and external stakeholders.
11. Assist in managing the flow of information between the payers, contracted MSO facilities and PMG
12. Coordinate and prepare reports
13. Record and track credentialing statistics
14. Other duties as assigned.

Experience:

• 7+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting
• Experience leading Enrollment teams with large provider inventory
• Demonstrated skills in problem solving, analysis and resolution
• Intermediate/advanced Microsoft Excel skills required
• Experience using Verity CredentialStream preferred
• Athena EMR experience preferred
• Experience supporting Medicare/Medicaid required
• Strong knowledge of NCQA guidelines & delegated payers preferred

Skills:

• Must be able to function independently
• Must possess demonstrated flexibility in multiple project management
• Must comply with HIPAA rules and regulations

Interpersonal Skills & Attributes:

• An individual with the ability to communicate appropriately and effectively with practitioners, internal stakeholders, and providers; including sensitive and confidential information
• High level of attention to detail with exceptional organizational skills
• Exercise independent judgment in interpreting guidelines of applicable regulatory bodies

Compensation:

The salary range for this role is $90,000 to $95,000 in base pay and exclusive of any bonuses or benefits.

Technical Requirements (for remote workers only):

Minimum internet speed: 5 MBPS download & 3 MBPS upload.

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