Managed Care Enrollment Specialist I (Remote)

Job Description:

Essential Job Functions:

• Compiles application documents for appropriate payers and communicate with providers for final signatures if applicable.
• Submits payer initial enrollment and revalidation applications in various formats and follows up with payers in a timely manner.
• Monitors, compiles and maintains up-to-date and accurate enrollment records for all providers and communicates accurately and timely to internal stakeholders.
• Creates timely and accurate reports for Managed Care payers and routine auditing of payer records. This includes compiling and distribution of reports to Managed Care payers to meet the organization’s delegated credentialing obligations.
• Ensure payers have the most accurate credentials, services and practice locations for providers by coordinating appropriate provider data modifications.
• Act as a liaison for the process of external privileging with other organizations for our contractual obligations.
• Maintain department standards while meeting all required regulations.
• Other duties as assigned

Knowledge, Skills, and Abilities:

• Excellent customer service, time management and communication skills (oral and written).
• Excellent organization skills and attention to detail.
• Analytical skills and the ability to research industry topics and policies and translate the information into actionable items.
• Must be able to multitask on various projects while meeting different deadlines

Experience and Education Qualifications:

• High school diploma, GED or equivalent required.
• Experience in healthcare administration utilizing advanced Microsoft Office and excel preferred.
• Healthcare Revenue Cycle experience preferred.

Supervisory Requirements:

• None

Employment Requirements:

• Successful completion of background check including criminal record, driving record, abuse/neglect and fingerprint check.
• Completion of New Hire Orientation at the beginning of employment.
• All training requirements including Relias at the beginning of employment and annually thereafter.
• Current driver’s license, acceptable driving record and current auto insurance.

Physical Requirements:

• The physical requirements and working conditions described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.
• While performing the duties of this job, the employee is regularly required to stand and walk and sometimes sit; use hands and arms; and talk or hear. Prolonged periods of sitting at a desk.
• The noise level in the work environment is usually moderate. The employee must be able to perform duties, both in office or while working remote and under all weather conditions.

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.