Enrollment Specialist, Medical Board

SUNY Downstate Health Sciences University•Brooklyn, NY

5d•Onsite

About The Position

SUNY Downstate Health Sciences University, a leader in healthcare and one of the nation's leading metropolitan medical centers, is seeking a full-time Enrollment Specialist / TH Staff Assistant 2 for its Department of Medical Board Credentialing. The university is the only academic medical center in Brooklyn, serving a diverse population, and is highly-ranked among the top U.S. medical schools for training doctors. The successful candidate will be responsible for overseeing managed care enrollment and delegated credentialing for providers, ensuring compliance with National Committee for Quality Assurance (NCQA) standards, federal regulations, and hospital policies. This role involves acting as the authorized official for government plans, managing provider enrollment operations, maintaining various databases, reconciling health plan rosters, and liaising with Medical Group Leadership to address financial ramifications of enrollment issues.

Requirements

High School Diploma.
2+ years of Managed Care Enrollment work experience.
2+ years of experience enrolling providers in Medicare and Medicaid.
Knowledge of CAQH Process.
Knowledge of NCQA Standards.
Or, a satisfactory equivalent combination of experience, education and training.

Nice To Haves

Knowledge of Symplr Cactus.

Responsibilities

Oversee the hospital's managed care enrollment and delegated credentialing for providers by maintaining compliance with National Committee for Quality Assurance (NCQA) standards, federal regulations, and hospital policies.
Act as the authorized official for government plans (Medicare & Medicaid).
Serve as the primary point-of-contact for day to day provider enrollment operations.
Maintain National Provider Identifier & Council for Affordable Quality Healthcare database on behalf of assigned providers.
Manage and update EMDNY and Pecos accounts.
Update provider panels and reassigns files.
Reconcile monthly health plan provider rosters for 25+ plans.
Schedules, prepares and conducts pre-audits of credentials files for on-site and desk delegated credentialing audits.
Manage the Managed care module In Cactus database to track provider demographics, CAQH IDs and payor participation status.
Act as a liaison with Medical Group Leadership to ensure provider cooperation and understanding of financial ramifications related to delayed or incorrect enrollments.
Respond to credentialing unbilled problems as indicated by the "holding report."
Analyze and update billing reports submitted by the finance department.
Reconciles billing denials with contracted billing vendors.
Perform other job related duties and responsibilities as required and/or needed.