Manager – Payer Enrollment

Manager – Payer Enrollment

Requirements

• 5+ years’ experience in managed care enrollment, billing, and/or Medical Staff service setting
• Athena EMR experience required
• Intermediate/advanced Microsoft Excel skills required – Pivot tables, VLOOKUP, etc.
• Must comply with HIPAA rules and regulations

Responsibilities

• Lead all enrollment activities to ensure provider participation status
• Lead all demographic updates to ensure provider termination; demographic updates are submitted to payers and processed
• Ensure protocols are followed to ensure timely resolution, completion of payor enrollment, and no revenue loss due to untimely enrollment.
• Assures compliance with all health plan requirements related to the provider certification and credentialing.
• Works with both internal and external stakeholders to provide regular updates and resolve complex provider enrollment status and/or issues, including resolving claim denials related to provider enrollment
• Collaborates with RCM leadership to identify enrollment issues affecting claims payments and develop an action plan to resolve them.
• Manages special projects that require understanding payer enrollment and its effects on claims processing.
• Interacts with varied levels of management, physician office staff, and physicians effectively to accomplish enrollment before implementation of new Care Center or Provider
• Maintain up-to-date data for each provider in credentialing databases, internal tracking systems, and Athena to ensure timely release of claims and notification to Care Center and providers of their enrollment status
• Mentor and train new and existing staff.
• Autonomously lead meetings with key internal and external stakeholders.
• Assist in managing the flow of information between the payers, contracted MSO facilities, and PMG.
• Coordinate and prepare reports
• Record and track enrollment statistics
• Other duties as assigned.

Preferred Qualifications

• 5+ years of people management experience preferred
• Experience with Texas Medicaid enrollment preferred
• Experience supporting Medicare/Medicaid preferred
• Experience using Verity CredentialStream preferred
• CAQH experience preferred