Integrated Resources Inc.
Health Plan Enrollment Analyst
Integrated Resources Inc., San Francisco, California, United States, 94199
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description
This position is responsible for developing and overseeing the processes ensuring that all billing providers (approximately 2000) at Client and affiliates are appropriately and accurately credentialed and enrolled into all commercially contracted health plans, Medicare, Medi-Cal and Tricare which is required to appropriately generate revenue (approximately $500 million annually) in the course of patient care. This position ensures that each billing provider is qualified to provide health care services in accordance with Client policies and procedures, The Joint Commission and NCQA standards, commercial contracted agreements, as well as State and Federal laws and regulations including the Affordable Care Act.This position works directly with leadership at both Medicare and DHCS to interpret changes in State and Federal regulations and the impact new regulations have on Client and develop new processes as necessary. This position works directly with Client billing agents and contracted health plans to resolve billing issues on a daily basis.The incumbent does serve in a position of being more knowledgeable about the Federal, State and Managed Care regulations.Qualifications
Bachelor’s degree or equivalent combination of education and experience;
graduate degree can be substituted for experience.Minimum of 8-10 years of work experience in healthcare environment
with specific emphasis in provider enrollment, managed care, health plans affairs at an academic medical center and/or medical staff operations.
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Job Description
This position is responsible for developing and overseeing the processes ensuring that all billing providers (approximately 2000) at Client and affiliates are appropriately and accurately credentialed and enrolled into all commercially contracted health plans, Medicare, Medi-Cal and Tricare which is required to appropriately generate revenue (approximately $500 million annually) in the course of patient care. This position ensures that each billing provider is qualified to provide health care services in accordance with Client policies and procedures, The Joint Commission and NCQA standards, commercial contracted agreements, as well as State and Federal laws and regulations including the Affordable Care Act.This position works directly with leadership at both Medicare and DHCS to interpret changes in State and Federal regulations and the impact new regulations have on Client and develop new processes as necessary. This position works directly with Client billing agents and contracted health plans to resolve billing issues on a daily basis.The incumbent does serve in a position of being more knowledgeable about the Federal, State and Managed Care regulations.Qualifications
Bachelor’s degree or equivalent combination of education and experience;
graduate degree can be substituted for experience.Minimum of 8-10 years of work experience in healthcare environment
with specific emphasis in provider enrollment, managed care, health plans affairs at an academic medical center and/or medical staff operations.
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