Managed Care Enrollment Coordinator II

HCA Healthcare • Houston, TX

2d

About The Position

This position supports the development and implementation of the Credentialing Processing Center’s managed care payor enrollment and re-enrollment processes. The coordinator reviews enrollment data and documents for hospitals and other entities, maintains entity and ownership information, follows up on missing information, and escalates expired or soon-to-expire credentials. The role also involves researching and resolving complex enrollment situations and supporting other tasks and projects as requested.

The coordinator serves as a subject matter expert on Credentialing Processing Center policies, procedures, and systems; maintains accurate, timely enrollment records; and helps ensure compliance with organizational policies and applicable federal and state regulatory and accrediting requirements. The position works with hospital leadership to address issues, supports audits, contributes to policy development, and maintains enrollment files and correspondence. The candidate must live within 60 miles of an HCA facility in Florida, Georgia, Idaho, Kansas, Kentucky, Missouri, North Carolina, New Hampshire, Nevada, South Carolina, Tennessee, Texas, Utah, or Virginia.

Requirements

• Associate’s degree or equivalent work experience.
• At least two years of experience in healthcare, such as healthcare credentialing, facility credentialing, Revenue Cycle Operations, a managed care setting, or a credentials verification organization.
• Professional telephone etiquette.
• Ability to work with minimal supervision and effectively both independently and in group environments.

Nice To Haves

• Experience with managed care enrollment and/or re-enrollment.
• Detailed working knowledge of the healthcare and/or managed care industry, including medical legal issues and laws, regulatory agencies, and national standards.
• Certified Specialist Managed Care (CSMC).

Responsibilities

• Serve as a subject matter expert on Credentialing Processing Center policies, procedures, and systems.
• Perform data integrity, specialist, and compliance reviews, including record preparation, final review, and flag assignment according to established requirements.
• Maintain high-quality, timely, and accurate managed care payor enrollment and re-enrollment processes.
• Identify documents that need renewal before their expiration dates.
• Obtain and review required information and documents, including state licenses, Federal and State DEAs, liability insurance, and other payor-required documents.
• Monitor incoming information; follow up on missing items or incomplete forms; and submit requests for required documents and approvals.
• Identify and evaluate potential issues, collaborate with hospital leadership to document and resolve confirmed issues, and escalate questionable information or process issues to the Manager and/or Director.
• Participate in policy development and deployment.
• Support hospitals during managed care payor enrollment and re-enrollment audits.
• Maintain enrollment and re-enrollment files and ensure correspondence is accurately filed.
• Stay current on enrollment processes and legal and regulatory requirements, and ensure compliance with applicable policies, regulations, and accrediting requirements.
• Analyze enrollment data to identify issues, patterns, and trends; generate reports; and implement corrective actions to support timely resolution and process improvements.
• Apply critical thinking to complex payer enrollment scenarios and develop solutions aligned with organizational goals and regulatory requirements.
• Practice and adhere to the Code of Conduct philosophy and Mission and Value Statement.
• Perform other duties as assigned.

Benefits

• Medical, prescription drug, dental, vision, behavioral health, and telemedicine services.
• Wellbeing support, including free counseling and referral services.
• Paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence.
• 401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
• Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.
• Tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
• Fertility and family-building benefits and adoption assistance.
• Life insurance and supplemental health protection plans.
• Auto and home insurance, legal counseling, identity theft protection, and consumer discounts.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree