P-17800 Managed Care Enrollment Specialist I

Job Description:

Job Title: Managed Care Enrollment Specialist

Location: Remote

Employment Type: Full-time

Job Summary:

This is a remote position under the direct supervision of the Managed Care Enrollment Supervisor, the Managed Care Enrollment Representative I is responsible for enrolling and revalidating providers with various managed-care payers including Medicare and Medicaid in a timely manner while maintaining an accurate account of enrollment statuses in the department database. This role entails completing payer specific applications and reports, acting as a liaison between external organizations and providers, reporting to payers and collaborating with other internal departments to resolve discrepancies.

The Managed Care Enrollment Specialist position offers…

• All-Inclusive Employee Benefits Package - A robust full-time employee benefits package encompassing health, dental, vision, retirement, disability, life insurance, wellness program, and more
• Telemedicine – 24/7 phone, web, or mobile app medical, behavioral health, & dermatology visits
• Employee Assistance Program – 24/7 counseling services, legal assistance, & financial consultation for you and your household at no cost
• Paid Time Off - 29 days per year including vacation & holiday pay

Key Responsibilities:

• Research and resolve provider related enrollment issues and coordinate with members of various departments when applicable.
• Coordinates all activities related to provider enrollment with various commercial and MCO plans.
• Complete provider enrollment applications to eligible insurance plans utilizing credentialing software to complete credentialing packets for associates for managed care contracting, and track status per contract in a timely manner.
• Monitor all submitted applications, enrollment status and complete follow-ups as needed.
• Prepare the CAQH for newly affiliated and existing providers.
• Maintain the provider files for revalidation of Medicare via PECOS.
• Re-attest CAQH information for providers as needed.
• Responsible for requesting individual provider numbers from Medicare, Medicaid, and other reimbursement entities either through written requests or electronic submission via the Internet.
• Update and maintain credentialing software including but not limited to adding new hires, new facilities as needed.
• Maintains all provider insurance enrollments, license, certifications, malpractice insurance and expirables.

Education and/or Experience Qualifications:

• Bachelor’s Degree in Healthcare Management, Business Administration, or Medical Billing
  OR
• Four years of experience in a healthcare, nonprofit, or insurance setting.

We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.

Preferred Family Healthcare is a Smoke and Tobacco Free Workplace.