Full-Time Manager, Provider Enrollment

Manager of Enrollment oversees the enrollment program, serving as the primary liaison for clinics, payers, billing, and practitioners.

Ensures accurate enrollment of healthcare providers with various plans (federal, state, marketplace, commercial).

Responsibilities include:

1. Leading all enrollment activities to maintain provider participation status.
2. Managing all demographic updates for provider termination.
3. Ensuring protocols are followed for timely resolution and payor enrollment to avoid revenue loss.
4. Maintaining compliance with all health plan requirements for provider certification and credentialing.
5. Working with internal/external stakeholders to address provider enrollment status/issues, including claim denials.
6. Collaborating with RCM leadership to identify/resolve enrollment issues affecting claims payments.
7. Managing special projects related to payer enrollment and its impact on claims processing.
8. Effective communication with various levels of management, physician office staff, and physicians to ensure enrollment before Care Center or Provider implementation.
9. Maintaining updated provider data in databases and internal systems for timely claims release and status notification.
10. Mentoring and training new and existing staff.
11. Leading meetings with internal and external stakeholders.
12. Assisting in managing information flow between payers, contracted MSO facilities, and PMG.
13. Coordinating and preparing reports.
14. Tracking enrollment statistics.

Requirements:

• 5+ years' experience in managed care enrollment, billing, or Medical Staff services.
• Experience with Texas Medicaid enrollment.
• Strong Excel skills.
• Proven problem-solving, analysis, and resolution skills.
• 5+ years of people management experience (preferred)
• Intermediate/advanced Microsoft Excel skills.
• Experience using Verity CredentialStream (preferred)
• Athena EMR experience
• Experience supporting Medicare/Medicaid (preferred)
• CAQH experience (preferred)
• Ability to function independently and exhibit flexibility in multiple project management situations.
• Compliance with HIPAA rules and regulations.

Salary: $68,000 - $75,000 base, plus potential bonus (up to 15%) and restricted stock units.

Technical Requirements (Remote): Minimum 5 Mbps download speed and 3 Mbps upload speed. Employees eligible for reimbursement to offset costs.

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