Enrollment and Contract Coordinator (Full-Time Remote, North Carolina Based)

The Enrollment and Contract Coordinator takes a lead role identifying and coordinating provider changes as notified by the PEF, CIN’s and Hospital systems, as well as completing and tracking PCP changes, to include coordinating and completing outreach to PCP practices, member and provider notifications and updating ACS or other relevant databases.  The Enrollment and Contract Coordinator will inform contracts department of any updates to contracts and will assist in the completion of the monthly Provider Termination Report and other identified reports.

This position will allow the successful candidate to work fully remote. They must be a resident of North Carolina and while no expectation of being in the office routinely, they must be able to report on site if ever required. 

 Responsibilities & Duties

Manage PEF Change Report

• Conduct daily reviews of the PEF Change report to identify changes to contracted providers that may impact member service
  
• Follow internal procedures to notify provider and members of follow up actions taken
  
• Update relevant internal stakeholders and Claims system when indicated 
  
• Monitor PEF change report for PCP and other provider NC Medicaid suspensions and terminations and coordinate provider outreach to reduce potential member transitions

Coordinating Provider Service and Contract Terminations

• Identify Inactive sites daily, outreach to providers, and coordinate PCP member reassignment when indicated within required timeframes
  
• Coordinate provider termination notifications as required by procedure

Provider Termination Report

• Work with Contracts Manager to ensure Alliance remains in compliance with provider terminations as mandated by DHHS
  
• Take the lead role for completing the State required monthly termination report

CIN and Hospital Service Terminations

• Review CIN rosters for changes to contracted provider status and ensure member notification and transition is completed within required timeframe

PCP and Provider Changes

• Coordinating and completing outreach to PCP practices, member and provider notifications and updating ACS or other relevant databases

Administration of Member Notifications of Provider Terminations

• Identify and coordinate member notification when a provider is terminated or when a PCP comes back in Network and follow internal procedures to notify members
  
• Verify that all member notifications meet contract requirements 

Process Documentation Management

• Take primary responsibility to maintain and update the Provider Termination and PCP transitions desk procedure based on internal and contractual requirements 

Provider Network Enrollment Processing Assistance

• Assist in the review of provider applications and determine enrollment eligibility based on contract requirements and assist in the coordination in contracting with eligible providers 

Minimum Requirements

Education & Experience

Bachelors degree from an accredited college or university in Social Sciences, Public health or another closely related field and three (3) years of experience in health care industry or provider network management. A relevant program area may be substituted for two years of the required experience.

Or

A master’s degree from an accredited college or university in Social Sciences, Public health, or another closely related field and one (1) year of experience in health care industry, or provider network management. 

Preferred:  

At least three (3) years of experience working in a Health Care, Managed Care, LME/MCO or Business setting that requires administrative, project management, or coordination responsibilities preferred.

Knowledge, Skills, & Abilities

• Thorough knowledge of contracting procedures
• Understanding of federal and state law, rules, regulations, guidelines, policies, and procedures applicable to LME-MCO contracting
• Working knowledge and understanding of computer-based contract maintenance programs; skill in organizing resources and establishing priorities
• Ability to work effectively with a wide range of individuals and groups in a diverse community
• Skill in computer use and database management
• Ability to review large amounts of data and manage multi-step processes from beginning to end 
• Ability to work independently in a fast-paced environment 

Salary Range 

$31.85-$41.40/Hourly 

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.  

An excellent fringe benefit package accompanies the salary, which includes:    

• Medical, Dental, Vision, Life, Long Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility