Provider Enrollment Specialist, Managed Care Contracting and Enrollment, Full Time, Days

Jackson Health System•Miami, FL

40d•Remote

About The Position

Managed Care Provider Enrollment Specialist assists the Provider Enrollment leadership (administrator/manager) and the department in the daily activities of the managed care department with respect to the enrollment of employed physicians and credentialing of the employed physicians and other assigned physicians with which the managed care team has been tasked to enroll in managed care plans. Develops and maintains positive relationships with managed care companies and serves as a point of contact regarding health plan enrollment and correcting of issues related to the same. Maintains a managed care provider enrollment grid with responsibilities for continuous communication, improvement and follow up with payors, physicians and management regarding provider enrollment.

Requirements

Generally requires 3 to 5 years of related experience.
Valid license or certification is required as needed, based on the job or specialty.

Nice To Haves

Bachelor's degree in related field is preferred.

Responsibilities

Works independently with internal and external resources to research and resolve issues with regard to enrollment in health plans, Medicare and Medicaid.
Meet, as necessary, with clinical staff to obtain necessary paperwork, signature and key documents needed for the processing of Medicare, Medicaid and managed care applications.
Maintains detailed records of physicians enrollment for distribution to physician office leadership.
Support management as necessary during health plan audits and participation in performing site visits.
Maintains issues logs and follows up on outstanding issues pertaining to successful enrollment in Medicare, Medicaid and health plans.
Coordinates closely with various departments to facilitate appropriate review and signatures on enrollment documents and regular updates to Billable Providers list.
Enter and maintain provider demographic/practice location information within the provider enrollment database.
Process Provider Enrollment applications with health plans, Medicare and Medicaid for all new providers.
Works closely with the external Medicare/Medicaid provider enrollment entities to discuss specific application/enrollment requirements including pre-requisites, forms required, form completion requirements, timelines, supporting documentation, and regulations.
Maintain Provider information by periodically verifying demographic/location information with corresponding department heads.
Responsible for providing practice information to all contracted health plans, Medicare and Medicaid.
Updates system to reflect approvals, denials and/ or terminations and communicate accordingly.
Track and follow up on re-credentialing/reappointment due dates for non-delegated health plans, Medicare & Medicaid.
Performs other related duties as assigned.
Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise).