Payor Enrollment Manager

Responsibilities:

• Coordinates across departments to strategize for health plan submission across new and existing states
• Monitor general enrollments for timely approvals
• Oversee Payor Enrollment in all states
• Manage Operations Associates-Payer Enrollment team members
• Hiring, corrective action, and termination needs
• Complete and submit supplementary paperwork for group enrollment applications
• Coordinate with and act as the primary point of contact for health plan reps to present questions/troubleshoot areas of issue
• Act as the primary point of contact for the credentialing platform software to present questions/troubleshoot areas of issue
• Serves as the first point of escalation for complex payer enrollment and credentialing cases; Troubleshoot issues that arise with health plans, including lack of clarity surrounding payer enrollments; Work with plans to implement short-term and long-term solutions
• Escalate communication with unresponsive/confused providers for issues surrounding Payor Enrollment
• Oversees centralized mailboxes used to centrally accept inquiries and requests both internally and externally
• Oversee timely updating of all credentialing status changes
• Maintain continuous active enrollment with health plans on behalf of providers
• Manage and coordinate all Payor Enrollment activities
• Measure and report on team KPIs, including payer enrollment timelines, associates' performance, approval volume, etc
• Perform audits on a routine cadence
• Collaborate with Credentialing Manager to support NCQA accredited delegation and provider onboarding
• Attend internal and external meetings and prepare agendas as appropriate; ensure communication lines remain open and routine meetings take place
• Maintain oversight on provider associate to fully licensed funnel
• Support the Product Team with the development and implementation of new resources; train team members on any applicable product launches
• Manage provider terminations with respect to CAQH, account deactivations, and disenrollment from health plan lines
• Maintain and distribute provider manuals to ensure compliance with health plan requirements amongst the corporate and clinical teams
• Oversees resolution of credentialing associated denials/underpayments
• Responsible for final review of submissions to payers
• Audits payer websites for erroneous or missing provider profile data
• Implements innovative data population methods to minimize manual intervention, decrease internal processing times, and reduce human error

Qualifications

• Bachelor's degree or equivalent in education and experience
• 4+ years of related healthcare experience, 2+ years of management experience
• Intermediate proficiency in Google Suite and Excel (including v-lookup and pivot tables) and related systems and databases
• Must be a motivated individual with a positive and exceptional work ethic
• Ability to work independently with follow-through and handle multiple tasks simultaneously
• Ability to work collaboratively with a culturally diverse staff, strong customer service skills, demonstrating tact and sensitivity in stressful situations
• This position requires the ability to interact positively, constructively, and effectively with internal and external parties and stakeholders in written and oral forms
• Must successfully complete training requirements
• Exceptional communication, conflict resolution, critical thinking, interpersonal skills, time and priority management skills, and researching skills in order to analyze a question or problem and reach a solution
• Adaptability to Change & Learning Agility
• Ability to liaise with and successfully navigate within health plans to gather accurate information
• Experience with Medicare (CMS I&A, PECOS) and Medicaid enrollments

Preferred Qualifications

• Up-to-date knowledge of NCQA credentialing standards
• Experience working with payers in multiple states
• Experience with NY Medicaid enrollments

Fair work deserves fair wages. At Valera, we value this role at between 70k-80k with the potential for an annual performance bonus based on experience.