Managed Care Analyst I

Driscoll Children's Hospital•Corpus Christi, TX

18h

About The Position

Responsible for all aspects of the credentialing, re-credentialing, enrollment process for hospital and hospital employed providers with contracted health plans. This role maintains up to date data for each provider in credentialing databases and online systems, ensuring timely renewal of licenses and certifications. The Managed Care Analyst I must understand the insurance plan requirements for credentialing various types of providers and will assist with establishing and maintaining administrative, legal, operational, and financial opportunities related to contract negotiation and implementation for all areas of managed care through research and analysis.

Requirements

Bachelor's degree (other related degrees will be considered based on applicability).
3-5 years' previous credentialing/enrollment or provider relations experience in related area.
Substantial knowledge of payer credentialing.
Knowledge of payer processes, local, state, and federal requirements.
High level of skills in operating a standard desktop and Windows-based computer system, including but not limited to, Microsoft Word, Excel, PowerPoint, Outlook, database applications, presentation software, Intranet and computer navigation.
Excellent organizational, analytical, time management and attention-to-detail skills for the execution of multiple assignments.
Ability to work collaboratively in a team-oriented environment; courteous, professional and friendly demeanor.
Ability to work independently with minimal supervision, plan, organize, prioritize assignments and responsibilities and time constraints in a fast-paced environment and adapt to them as they change frequently.
Strong oral and written communication skills.
Strong organizational skills.
Ability to cross-train in other areas of the department in order to achieve smooth flow of all operations.
Ability to multi-task and work on multiple projects simultaneously.

Nice To Haves

Bachelor's degree in Business Administration or Health Care Administration preferred.
Prior experience with EPIC is a plus.

Responsibilities

Maintain utmost level of confidentiality at all times.
Adhere to hospital policies and procedures.
Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Compiles and maintains current and accurate data for hospital and hospital employed providers.
Maintains copies of current state license, CLIA certificates, education requirements and any other required credentialing documents for hospital and hospital employed providers.
Ability to communicate effectively with all stakeholders across the health system, furthermore, disseminate manage care credentialing updates to key senior leaders across the health system.
Maintains knowledge of current health plan and hospital requirements for credentialing providers.
Sets up and maintains provider information in online (internally and external insurance companies) payer credentialing databases and systems.
Tracks licenses and certification expirations for all providers to ensure timely renewals.
Establishes and maintains provider files to include necessary documentation and understands the plan requirements for credentialing a provider with all of insurance carriers we currently participate with for all types of providers.
Assist departmental leadership in resolving managed care operational issues and provide interpretation of managed care policies, terms, and conditions.
Knowledge of Medicare and Medicaid provider enrollment rules and guidelines.
Complete enrollment applications for various state Medicaid plans.
Initiate and support the facility credentialing application process by sending, receiving, analyzing facility documents to determine appropriateness for the facility verification process.
Gather, verify, and evaluate confidential and sensitive organizational information, consistent with facility credentialing application requirements.
Follows up on the status of applications and provider licenses and facilitates the renewal process; tracks the progress on all pending applications and works to resolve issues as they arise.
Oversees provider online database, tracks licensure expirations and ensures that updated licensures are received.
Manage documentation and proper communication workflows for all new provider credentialing.
Supports special project work as needed.
Assumes additional duties as required.