Credentialing, Enrollment and Licensing Specialist (Enrollment)

Imagine Pediatrics

6h • $55,000 - $65,000

About The Position

Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity.
As a Credentialing, Enrollment and Licensing Specialist (Enrollment) at Imagine Pediatrics, you will play a critical role, enabling our providers to make sure every child with complex medical conditions gets the care and support they deserve. You will:

Requirements

• 3-5+ years of experience handling Payer enrollments, preferably for multi-disciplinary Provider groups.
• Extensive experience with Medicaid in a multi-state organization.
• Working knowledge of clinical operations and procedures.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to maintain confidentiality and discretion in all communications on behalf of Imagine Pediatrics Providers.
• Demonstrated advanced working knowledge of Verifiable, Athena, and Microsoft Office suite.
• Advanced skills in computerized spreadsheeting and database management.

Nice To Haves

• Telehealth experience strongly preferred.

Responsibilities

• Manage payer enrollments for multi-disciplinary Providers with state Medicaid and payer partners, where applicable.
• Communicate clearly with providers, their liaisons, medical leadership and administration, as needed, to ensure application completeness and accuracy.
• Complete all applications electronically or via mail as prescribed by state Medicaid agencies and payer partners.
• Perform follow-up on enrollments via portal, phone, fax, or other prescribed process by state Medicaid agency and payer partners.
• Perform monthly roster reconciliation with payer partners to ensure accuracy of Provider records; ensure all adds, terms, and demographic updates are included in reconciliation process to avoid any impact to claims processing.
• Identify, analyze, and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact the ability to establish and maintain Provider enrollments.
• Discover and convey roadblocks to Enrollment to Senior Manager for sound decision making in accordance with Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
• Maintain professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Perform miscellaneous job-related duties as assigned.

Benefits

• The role offers a base salary range of $55,000 - $65,000 in addition to annual bonus, competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary.
• Full medical, dental, and vision insurance
• Healthcare and Dependent Care FSA
• 401(k) with 4% match, vested 100% from day one
• Life insurance at 1x annual salary
• 20 days PTO + 10 Company Holidays & 2 Floating Holidays
• Paid parental leave
• Additional benefits to be detailed in offer

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed