Health Plan Enrollment Analyst

Health Plan Enrollment Analyst

Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.

Job Description

This position is responsible for developing and overseeing the processes ensuring that all billing providers (approximately 2000) at Client and affiliates are appropriately and accurately credentialed and enrolled into all commercially contracted health plans, Medicare, Medi-Cal and Tricare which is required to appropriately generate revenue (approximately $500 million annually) in the course of patient care. This position ensures that each billing provider is qualified to provide health care services in accordance with Client policies and procedures, The Joint Commission and NCQA standards, commercial contracted agreements, as well as State and Federal laws and regulations including the Affordable Care Act. This position works directly with leadership at both Medicare and DHCS to interpret changes in State and Federal regulations and the impact new regulations has on Client and develop new processes as necessary. This position works directly with Client billing agents and contracted health plans to resolve billing issues on a daily basis. The incumbent does serve in a position of being more knowledgeable about the Federal, State and Managed Care regulations.

Qualifications

Bachelor's degree or equivalent combination of education and experience; graduate degree can be substituted for experience. Minimum of 8-10 years of work experience in healthcare environment with specific emphasis in provider enrollment, managed care, health plans affairs at an academic medical center and/or medical staff operations. Knowledge of the regulations (TJC, CMS, CDHS, NCQA, HCFA etc.) regarding the operations of a Provider Enrollment operation, and/or Medical Staff Services Office, and/or a Credentialing Verification Office. Able to review and understand local, state, and federal regulations. Previous experience working in a work environment that requires a high-level of confidentiality and sensitivity, and an understanding of the regulatory requirements for maintaining this confidentiality. Ability to maintain confidentiality and use discretion when handling sensitive medical staff issues. Ability to organize, prioritize, and monitor assignments and workload. Possess ability to set priorities and manage multiple demands effectively. Ability to work with and lead credentialing staff with special performance improvement projects. Excellent, proven writing skills and outstanding organization/planning skills to anticipate workload deadlines. Proficiency with MS Office, Epic EMR system, HLS/ECHO, or other credentialing software. Excellent communication, conflict-management skills, and customer-service skills. Ability to interact with all levels of the Medical Staff, including Medical Staff leaders, Department Chairs, Division/Service Chiefs, and medical staff providers. Ability to function well within a team and independently.

Additional Information

Preferred Master's Degree in Business Administration, Public Health, Public Administration. Previous experience with Medical Staff credentialing or medical staff/governance committees and/or working with highly confidential/sensitive materials. Required Licenses/Certifications CPC or CPCS/CPMSM certification (or obtained within 1 year of hire)

Careers Integrated Resources Inc