Managed Care Delegation Specialist

SSM Health • MO-SSM Health Mission Hill, MO

3d • Hybrid

About The Position

Responsible for provider enrollment with commercial payors, managed care contracts, and delegation audit activities for the system hospitals or organization. Works independently with complex data and situations.

Requirements

• High School diploma/GED or 10 years of work experience
• Three years' experience in medical office setting
• Experience with credentialing databases.
• Proficient in all Microsoft applications, advanced proficiency with Excel.
• Experience with provider relations and navigating issues.
• Strong communication skills both written and verbal are required.

Responsibilities

• Ensures providers are credentialed and enrolled in insurance plans.
• Acts as a liaison between medical staff offices, credentialing verification offices, and delegation payors.
• Remains knowledgeable of medical staff bylaws, rules and regulations, and policies for the system hospitals or organization.
• Stays up to date with National Committee for Quality Assurance (NCQA) standards and reports back to stakeholders with new information pertinent to credentialing.
• Manages delegated credentialing processes and assists in contracting with managed care plans.
• Reviews and interprets new and existing contracts to ensure they meet Managed Care Organization (MCO) specifications.
• Negotiates recommended changes to contracts to ensure compliance.
• Ensures monthly and quarterly notifications for provider updates are distributed.
• Provided notifications of on-going rosters, new providers, resignations and/or change of status requests, location changes, and/or changes in provider privileges.
• Utilizes a variety of databases and query tools to gather data.
• Ensures all requirements are well-defined from the MCO to meet reporting and analysis specifications.
• Works closely with team members to establish reporting and dashboards within applications that will support operations.
• Resolves reimbursement discrepancies with payors for credentialing issues.
• Performs other duties as assigned.

Benefits

• One week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Instant access to earned, unpaid base pay before payday through DailyPay (fees may apply).
• Upfront tuition coverage through FlexPath Funded for eligible team members.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED