Managed Care Operations Specialist

Bronson Healthcare

21h•Hybrid

About The Position

The ideal candidate is detail-oriented, organized, willing to learn, and able to work both independently and collaboratively in a fast-paced environment. Bronson Healthcare is a community-owned, not-for-profit health system that has been serving southwest Michigan since 1900. Today, with a workforce of 9,000 people and 1,500 medical staff members, it is the area’s largest employer and leading healthcare system. Bronson provides care in virtually every specialty and offers a full range of services from primary care to critical care at more than 100 locations. Bronson’s exceptionally high quality standards enable us to do what’s right for our patients and their families. We are empowered as individuals and as teams, to apply our skills and experience so that every patient receives safe, timely and effective treatment. What’s more, our state-of-the-art, technology and evidence-based processes give us the tools we need to deliver the right care, at the right time. By putting each patient and their family at the center of our work, we demonstrate the dignity and respect we have for each individual we serve. This unwavering commitment to serving others combined with our unique healing environment helps make the patient experience here an exceptional one. The excellence and Positivity of our employees and medical staff has contributed to Bronson Healthcare being ranked by Forbes as one of America’s Best-In-State Employers (2022-23), by Newsweek as one of America’s Greatest Workplaces for Women (2023) and by the National Association for Business Resources as one of the 2023 Top 101 Best and Brightest Companies to Work For.

Requirements

High School Diploma or GED.
Minimum 2 years of experience in a healthcare environment (e.g., billing, credentialing, enrollment, payer operations, medical office).
Proficiency with computers, Microsoft Office, and web-based applications.
Strong attention to detail and ability to multitask.
Ability to work independently and collaboratively.
Strong written and verbal communication skills.

Nice To Haves

Associate’s degree in business, healthcare administration, or related field.
Experience with payer portals (Availity, CHAMPS, NPPES, etc.).
Background in credentialing, enrollment, revenue cycle, or managed care activities.
Familiarity with Epic and CAQH ProView.

Responsibilities

Complete routine validations in Availity and other payer portals.
Perform routine provider and facility validations in applicable state, federal, and commercial payer systems.
Upload and maintain Certificates of Insurance (COIs) in CAQH and applicable systems.
Ensure practice and provider demographics are accurate across internal and external databases.
Complete out-of-state Medicaid work queues in Epic to support accurate enrollment and billing.
Assist with updating provider signature forms, demographic details, locations, and related documentation.
Maintain accurate documentation for auditing, enrollment, and provider data management tasks.
Help monitor and validate data required by governmental and commercial payers.
Conduct annual payer directory audits to verify accuracy of provider and location information.
Identify discrepancies in payer or internal systems and escalate or resolve as appropriate.
Maintain internal logs, shared folders, documentation templates, and tracking tools.
Support the integrity of managed care contracts, credentialing, and enrollment databases.
Respond to internal inquiries regarding payer portal access, enrollment status checks, or data updates.
Assist with developing and updating standard work documentation.
Provide project support and assist with reporting or operational tasks across the Managed Care team.
Maintain confidentiality of all provider, facility, and organizational information.
Performs other duties as assigned.