Insurance Enrollment Specialist - Full Time / Days

Island Health•Anacortes, WA

1d•Onsite

About The Position

At Island Health, people are at the center of everything we do. As a part of the Patient Accounts team, you’ll play a vital role in supporting our mission to care for those who care for others. You’ll help create a positive and seamless experience for every team member — ensuring they feel valued, supported, and heard. Reporting to the Director of Patient Accounts, the Insurance Enrollment Specialist is responsible for (1) overseeing and coordinating the insurance enrollment process for new and established practitioners, (2) preparing financial and risk analysis to support payer contract management and negotiations, and (3) maintains client billing system. The role ensures providers meet payer/health plan requirements and accurate provider database management, performs analyses to evaluate historical and future contract performance, performs payer contract negotiations, and ensures accurate monthly billing of clients.

Requirements

High school diploma or equivalent required.
At least two (2) years of administrative experience in a hospital or healthcare setting.
Minimum three (3) years of data or financial analytical experience.
Proven experience working directly with healthcare personnel, including physicians and credentialing representatives.
Broad understanding of computer system concepts and database relationships; ability to create reports from data across systems for senior management.
Proficiency in Microsoft Excel and Microsoft Office Suite (Access, Word, Excel, Project, PowerPoint, Outlook).
Working knowledge of data management software applications.
Excellent written/verbal communication, interpersonal, negotiation, and presentation skills; ability to educate diverse audiences and explain analytic logic to stakeholders.
Strong analytical, investigative, organizational, and critical thinking skills; ability to synthesize information and concisely communicate findings and recommendations.
Detail-oriented; strong problem-solving, conflict resolution, time management, and task prioritization skills; ability to meet deadlines and work independently with minimal supervision.

Nice To Haves

Insurance enrollment experience preferred.
Experience working with cross-functional departments to research and resolve issues using innovative solutions preferred.

Responsibilities

Manage end-to-end provider enrollment and re-enrollment in compliance with federal/state regulations and accreditation standards (e.g., CMS, Joint Commission, NCQA, HIPAA).
Manage facility and clinic validation and re-validation with all applicable payers.
Maintain complete and accurate enrollment files.
Coordinate with providers, medical staff, contracting, and administrative teams to obtain required documentation and resolve application issues.
Monitor application status, communicate deficiencies, prepare enrollment correspondence, and ensure timely approvals and renewals.
Safeguard confidentiality of enrollment and privileged information and provide responsive customer service to internal and external stakeholders.
Perform financial, reimbursement, and risk analyses to support payer contract negotiations and ongoing contract management.
Build and maintain financial models to evaluate historical performance, forecast future reimbursement, and assess contract terms.
Prepare routine and ad-hoc reports for leadership to support strategic and operational decisions.
Review contract language to ensure correct application of rates and provisions and provide guidance on complex reimbursement scenarios.
Support managed care initiatives, including forecasting reimbursement impacts during negotiations and participating in collaborative managed care committees.
Educate leaders and physicians on reimbursement methodologies and payment structures as needed.
Maintain the client billing system for non-patient accounts and ensure accuracy of related data and reporting.