The Provider Enrollment Subject Matter Expert
About The Position
The Provider Enrollment Subject Matter Expert interacts professionally with providers and ancillary staff to provide appropriate and timely response to inquiries, escalations or concerns regarding provider enrollment and file maintenance for Texas State Health-Care Programs. Monitors the daily operations of enrollment activities to ensure daily inventory requirements are met per contractual obligations. Acts as Subject matter expert and escalation point to resolve issues and continuously look to improve accuracy and the employee experience. Monitors and review internal and external Quality Assurance results in order to improve daily processing of applications and file maintenance transactions. Participates and contribute to the development of strategic long and/or short-range goals. Makes recommendations to management to improve efficiency/effectiveness of current manual processes. Maintains strict confidentiality of information and job files as dictated by current HIPAA requirements. Maintains flexibility to work overtime as dictated by daily production inventory requirements. Performs other duties as assigned by leadership.
Requirements
- Minimum of 1 year of experience in the enrollment or credentialing of healthcare providers or 1 year of previous insurance experience
- Excellent verbal and written communication
- Ability to prioritize multiple tasks of high importance
- Proficiency with MS Office, Phoenix, PPM, PEMS
- Organizational and time management skills
- Strong analytical and problem-solving skills
- Ability to thrive in a deadline driven environment
- Attention to detail
Nice To Haves
- Experience in the enrollment or credentialing of healthcare providers
- Previous supervisory or team leader experience preferred
- Bachelor’s degree in business administration, Healthcare Administration or related discipline
- Experience with State and internal department interactions
Responsibilities
- Interact professionally with providers and ancillary staff to provide appropriate and timely response to inquiries, escalations or concerns regarding provider enrollment and file maintenance for Texas State Health-Care Programs.
- Monitor the daily operations of enrollment activities to ensure daily inventory requirements are met per contractual obligations.
- Act as Subject matter expert and escalation point to resolve issues and continuously look to improve accuracy and the employee experience.
- Monitor and review internal and external Quality Assurance results in order to improve daily processing of applications and file maintenance transactions.
- Participate and contribute to the development of strategic long and/or short-range goals.
- Make recommendations to management to improve efficiency/effectiveness of current manual processes.
- Maintain strict confidentiality of information and job files as dictated by current HIPAA requirements.
- Maintain flexibility to work overtime as dictated by daily production inventory requirements.
- Perform other duties as assigned by leadership.
Benefits
- medical, dental, vision, life, and long-term disability coverage
- a 401(k) plan
- bonus opportunities
- paid holidays
- paid time off
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
