Senior Managed Care Specialist-(PROVIDER ENROLLMENT)

About the role

The Senior Managed Care Specialist - PROVIDER ENROLLMENT is responsible for managing provider enrollment duties and tasks, implementing and maintaining all data and activities related to the enrollment of hospital employed or contracted physicians into all contracted insurance programs, including State Medicaid programs. Their primary goal is to ensure efficient and cost-effective healthcare delivery while maintaining high-quality standards.

Responsibilities

• Independently execute and manage managed care tasks within own area of responsibility (e.g., provider enrollment and credentialing, claims, payor issues).
• Work closely with internal and external teams (e.g., clients, customers) to coordinate, clarify information, and resolve issues.
• Support payer communications efforts (e.g., new publications, guidelines) and other supportive documentation.
• Manage denial issues related to contractual, enrollment or credentialing issues in a timely manner; monitor own delivery for compliance with overall guidelines, policies & procedures.
• Perform other duties as assigned to meet the goals and objectives of the department and institution.
• Maintains regular and predictable attendance.

Requirements

• High school diploma/GED required.
• Minimum 4+ years of experience in a healthcare, academic or research setting.
• Experience in healthcare office environment with some understanding of managed care contract and reimbursement models.
• Proven performance in earlier role.
• Experience with EPIC and CREDENTIALSTREAM preferred.
• Prior PROVIDER ENROLLMENT experience is strongly preferred.

Pay

A reasonable estimate of the current salary range is $29.00 - $50.50 per hour for the role of Senior Managed Care Specialist-(PROVIDER ENROLLMENT).

Schedule

This position requires a minimum of 2 days/week onsite.