Payor Enrollment Specialist

General Summary of PositionThe MedStar Corporate Managed Care team is seeking a full time Payor Enrollment Specialist to join our team. This is a Full-Time, Monday – Friday position, 8:30am - 5:00pm. The selected candidate will enjoy a hybrid schedule with the opportunity to work from home with infrequent on-site requirements. Office location is Rosedale, Maryland.As a Payor Enrollment Specialist, you will facilitate provider enrollment and managed care insurance credentialing/re-credentialing processes to ensure employed and/or contracted practitioners and facilities are enrolled timely in payor panels on behalf of the MedStar hospitals and MedStar Ambulatory Medical Groups, including physicians, allied health professionals, and ancillaries in MD, DC, and VA. Builds and maintains positive relationships with managed care insurance/payors and serves as a central point of contact regarding managed care insurance/payor issues.Primary Duties and Responsibilities• Coordinates, monitors and maintains the credentialing/re-credentialing of all practitioners employed and/or contracted for commercial and MCO payors. Obtains all necessary approvals and signatures, verifies all documentation is complete, and submits timely credentialing packets.• Follows up with managed care organizations regarding the credentialing status and provider numbers. Responsible for maintaining the accuracy and integrity of the credentialing database.• Independently handles requests, for additional information, from managed care organizations. Also identifies and responds pro-actively to issues and concerns regarding practitioner setup.• Notifies managed care organizations of provider changes (such as address changes, terminations, etc.). Provides oral and written follow-up to the managed care organizations to confirm the changes have been made. Generates and distributes provider number reports upon request. Constantly seeks out ways to improve communication and the flow of information to our internal and external customers.• Tracks and monitors the credentialing/re-credentialing process of managed care organizations and works closely with these payors in order to expedite the credentialing/credentialing process to ensure that practitioners are being credentialed and added to provider networks.• Works closely with internal finance and service line customers along with internal/external billing groups to resolve credentialing and outstanding Accounts Receivable/revenue issues.• Works directly with practitioners, service line leaders, practice administrators, and hospital executives to initiate the credentialing/re-credentialing process. Partners with Medical Staff offices and Executive Administration on new service line initiatives.• Works pro-actively with managed care organizations and government programs to stay current on policies and regulations governing credentialing/enrollment/plan participation. Educates internal customers on relative updates & changes and impact on relative business operations.• Participates in meetings and on committees and represents the department and hospital in community outreach efforts.Minimum QualificationsEducation• Bachelor's degree preferred or (equivalent work experience) in business, or related health care discipline required• One year of relevant education may be substituted for one year of required work experience.Experience• 5-7 years health care experience in managed care credentialing, payor relations and physician relations including experience working for a managed care insurance plan required• Experience with practitioner credentialing process, and experience completing managed care credentialing applications required• Customer service and managed care contract experience preferredKnowledge, Skills, and Abilities• Excellent verbal and written communication skills.• Strong organizational, interpersonal, and critical thinking skills.• Ability to work independently with minimum supervision.• Ability to analyze and evaluate data and other provider-related problems and to develop alternative solutions for a positive outcome.• Must be able to multi-task and prioritize workload and pay meticulous attention to detail.• Proficient in Microsoft Office software programs (Word, Excel, and PowerPoint).• Credentialing software experience required.This position has a hiring range of $23.19 - $38.49