Full-Time Manager, Payer Enrollment

The Manager, 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:

• 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
• Assures compliance with all health plan requirements as related to the provider certification and credentialing.
• Reviews and streamlines processes and workflows for the on-boarding department, using automation, where appropriate
• 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
• 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
• Oversees special projects requiring knowledge of delegated and non-delegated health plan requirements
• Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
• 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.
• Mentor and train new and existing staff.
• Autonomously lead meetings with key internal and external stakeholders.
• Assist in managing the flow of information between the payers, contracted MSO facilities and PMG
• Coordinate and prepare reports
• Record and track credentialing statistics
• Other duties as assigned.

Experience:

• 5+ years’ experience in managed care credentialing, billing and/or Medical Staff service setting
• Experience leading Enrollment teams with large provider inventory

Skills:

• Demonstrated skills in problem solving, analysis and resolution
• Intermediate/advanced Microsoft Excel skills
• Experience using Verity CredentialStream preferred
• Athena EMR experience preferred
• Experience supporting Medicare/Medicaid required
• Strong knowledge of NCQA guidelines & delegated payers preferred
• Must be able to function independently, 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.

What is the last date for applying to the job?

Which countries are accepted for this remote job?