Managed Care/ Payer Enrollment Specialist

JOB TITLE : Managed Care / Payer Enrollment Specialist

DEPARTMENT : REVENUE INTEGRITY

EXEMPT FROM OVERTIME : Yes

JOB SUMMARY

With a patient centered culture, the Managed Care / Payer Enrollment Specialist will manage daily activities related to providing operational support for Payer Enrollment. This role manages accounting and information systems in support of Managed Care / Payer Enrollment and develops strategies for improving levels of reimbursement under managed care agreements. Develops and helps guide organizational structure and processes necessary to support managed care agreements and is responsible for working directly with Managed Care Organizations to resolve enrollment and administrative escalations occurring with Managed Care contracts.

MINIMUM QUALIFICATIONS

Education :

• High School Diploma or GED (Required)
• Bachelor's Degree

Experience / Physical Requirements :

Light Work : Frequent lifting and / or carrying of objects weighing up to10lbs with a maximum lifting of 25 lbs.One to three years of current provider credentialing experience required. Previous Hospital Credentialing experience required. Basic to working knowledge of Centers for Medicaid and Medicare and Managed Care concepts including Managed Medicare / Medicaid requirements, Disclosure of Ownership and Control Interest, and applicable laws / statutes / regulations. Previous experience working with hospital contracts or demonstrated knowledge of contract principles, and interpretation of contract language.

Licensure / Certification :

Mission : To enhance the health of the communities we serve, one person at a time.

Vision : Our exceptional team will provide an extraordinary patient experience, compassionate care and clinical excellence.

Values : Integrity

Commitment

Accountability

Respect

Excellence

JOB SPECIFIC RESPONSIBILITIES

ComplianceThe Managed Care / Payor Enrollment Specialist maintains contracting database to monitor facility compliance with medical licensure, DEA, and Certificate of Insurance / Malpractice coverage. Run reports to monitor compliance and address non-compliance in a timely and proactive manner. Enrollment ActivitiesThe Managed Care / Payor Enrollment Specialist Assist facility credentialing in the preparation of Disclosure of Information documents requiring corporate validation and signature. Responsible for coordinating payor enrollment and re-enrollment activities. Prepares and submits initial state Medicaid enrollments and re-validations. Prepares and administers facility information to the NPPES website. This will include both NPI's for facilities as well as Group NPI's for physician billing.Communication / EducationThe Managed Care / Payor Enrollment Specialist communicates and coordinates the payor enrollment process in the sharing of information to internal leadership teams. Identifies and communicates risks posing negative compliance and / or financial impact to leadership. Assists departments in trainings, presentations and payor related meetings.Quality AssuranceThe Managed Care / Payor Enrollment Specialist maintains appropriate Managed Care Organizations documentation as required by MCOs. Develops payer performance and monitoring tools. Investigates and resolves Payor Enrollment issues; creates processes for opportunities for improvement.Data ManagementThe Managed Care / Payor Enrollment Specialist conducts data analyses / reports to the Chief Revenue Cycle Officer on payments and operational issues associated with Manager / Care Payor Enrollment. Maintains preferred vendor relationships and manage vendor requests as it relates to Managed Care / Payor Enrollment information.

Work Schedule : Days

Status : Full Time Regular 1.0

Location : Hartman Run Road

Location Of Job : Mon Health Medical Center

Disclaimer :

I understand that this document is intended to describe the general nature and level of work being performed. The statements in the documents are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

ADA DISCLAIMER :

This description does not state or imply that the duties listed above are the only duties to be performed by the positions incumbent. Employees are required to follow job-related instructions and perform other job-related activities requested by their supervisors. All requirements are subject to possible modification to provide a reasonable accommodation to individuals with physical or mental disabilities as defined in the Americans with Disabilities Act. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves, the patients, or other employees.