Full-Time Manager, Payer Enrollment

Manager, Payer Enrollment

The Manager, Payer Enrollment facilitates the enrollment program, serving as a primary liaison for clinics, payers, billing office, and practitioner-related issues.

1. Ensuring Timely Payor Enrollment: Follows protocols to ensure timely resolution and completion of payor enrollment to avoid revenue loss.
2. Compliance with Health Plan Requirements: Assures compliance with all health plan requirements for provider certification and credentialing.
3. Process Streamlining: Reviews and streamlines on-boarding processes/workflows using automation where appropriate.
4. Stakeholder Management: Works with internal/external stakeholders for regular updates, resolves complex provider enrollment/claim denial issues.
5. Tool Development and Reporting: Works with technical staff to develop tools/procedures for auditing and reporting to streamline processes and communications.
6. Special Project Oversight: Oversees projects requiring knowledge of delegated/non-delegated health plan requirements.
7. Effective Communication: Interacts effectively with varied levels of management, physician office staff, and physicians for credentialing and implementation/launch.
8. Data Maintenance: Maintains accurate provider data in credentialing databases and online systems; ensures timely license/certification renewals, and maintains confidentiality.
9. Mentorship and Training: Mentors and trains new/existing staff.
10. Meeting Leadership: Leads meetings autonomously with key internal/external stakeholders.
11. Information Flow Coordination: Assists in managing information flow between payers, contracted MSO facilities, and PMGs.
12. Report Preparation and Tracking: Coordinates and prepares reports, records and tracks credentialing statistics.
13. Other Duties: Performs other duties as assigned.

Experience & Skills:

• 5+ years of experience in managed care credentialing, billing, or Medical Staff service setting.
• Experience leading Enrollment teams with large provider inventory.
• Strong problem-solving, analysis, and resolution skills.
• Intermediate/advanced Microsoft Excel skills.
• Experience with Verity CredentialStream (preferred).
• Athena EMR experience (preferred).
• Medicare/Medicaid support experience (required).
• Strong knowledge of NCQA guidelines & delegated payers (preferred).
• Ability to function independently and demonstrate flexibility in multiple project management.
• Compliance with HIPAA rules and regulations.

Interpersonal Skills:

• Excellent communication skills to interact appropriately with practitioners, internal stakeholders, and providers, including sensitive/confidential information.
• High attention to detail and exceptional organizational skills.
• Independent judgment in interpreting regulatory guidelines.

Salary & Benefits:

Base pay: $65,000 - $75,000 (exclusive of bonuses/benefits).

Annual bonus: Targeted at 15%.

Restricted stock units (RSUs) available.

Benefits: medical, dental, vision, life, and pet insurance, 401K, paid time off (PTO), and wellness programs.

Salary determined based on experience, education, geographic location.

All information kept confidential (EEO guidelines).

Technical Requirements (Remote Workers):

• Minimum Download Speed: 5 MBPS
• Minimum Upload Speed: 3 MBPS

Internet speed tests (e.g., speedtest.net) required.

Expense reimbursement for home office costs.

Company commitment to a welcoming environment for all.

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