Managed Care/ Payer Enrollment Specialist

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.

Requirements

High school diploma or equivalent required. Bachelor's degree preferred.

Requirements

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

Certified Provider Credentialing Specialist (CPCS) certificate preferred or willingness to sit for CPCS within one (1) year of hire