Managed Care Senior Provider Enrollment Specialist

The Senior Provider Enrollment Specialist is responsible for ensuring the smooth transfer of information between requesting parties and the provider enrollment team. They will act as a team leader for Provider Enrollment Specialists, have a working knowledge of all enrollment needs and functions across all services lines, and maintain documentation of open enrollment items and assignments. They will also complete and follow up on provider applications with third-party payers by coordinating with enrollment vendors, payors, and internal stakeholders. This position serves as the department's subject matter expert for all group and/or provider enrollment, disclosure of ownership forms and group enrollment questions. As well as documents and records all group related information in the Provider Enrollment system and other applicable systems. Strong attention to detail, balanced with the ability to track a high volume of open projects while being a resource for the team, is essential to this role.

• Act as team leader to fellow Provider Enrollment Specialists; serve as subject matter expert for the team's workflows, systems, and other tools used in the department.
• Act as point person for tracking receipt of all enrollment documentation and requests; have a working knowledge of all enrollment needs and functions across all service lines.
• Work closely with Managed Care Acquisitions Manager to ensure newly acquired agencies are enrolled with appropriate plans.
• Complete a variety of third-party payer applications for all LHC Group providers.
• Completes and distributes W-9 forms.
• Assist during payor-delegated credentialing audits.
• Monitor any and all demographic changes. Update internal systems with new information and provide updates to payors based on their requirements.
• Maintain documentation of all open enrollment items and assignments; collaborate with team and Provider Enrollment Manager to ensure the maintenance of established departmental performance metrics for production and quality.
• Research and resolve enrollment and claims issues; initiate contact with payors and practices via telephone or electronic methods with respect to provider enrollment initiation or billing errors, utilizing proper customer service protocol.
• Research and coordinate the gathering of payor requirements including, but not limited to state regulations, processing timeframs, change of ownership process and required documentation, backdate requests, health plan backlogs, adverse legal history, required group enrollment documentation, delegated information and payer timeframes for submission.
• Prepare and review all group Disclosure of Ownership (Government and Commercial) and group enrollment and re-enrollment applications, as required.
• Upon receipt of enrollment approval, communicate updates and/or questions to internal departments and all external parties utilizing parties' available tools (i.e. portals and/or directories)
• Serve as subject matter expert for all group provider enrollment related activity.
• Establish and maintain a strong professional rapport with providers, third party payers, clients and internal staff.
• Review correspondence received and perform appropriate action to resolve.
• Appropriately resolve or escalate payor application denials.
• Maintain working knowledge of departmental workflow, systems, and tools.
• Other duties, as assigned.

Formal Education: High School Diploma or equivalent; College education preferred

Experience Reauirements: Two years or more of related healthcare experience, such as Medicare/Medicaid Enrollment, Managed Care Enrollment, or provider credentialing.

Skill Requirements

• Must be highly organized, efficient, and able to handle multiple tasks with ease and professionalism.
• Must possess administrative, analytical, problem-solving, and time management skills.
• Must be able to make sound decisions based on urgency, fact, guidelines, goals, and regulations.
• Must have a thorough working knowledge of computers and applicable office software including Microsoft Office Suite (Adobe Professional, Outlook, Word, Excel, Access, Power Point), internet research, and database programs.