Healthcare Enrollment Specialist

2 weeks ago


San Francisco, California, United States Integrated Resources Inc. Full time

Integrated Resources, Inc. is a leading staffing agency known for its exceptional service and integrity in the healthcare sector. Established in 1996, we have earned a reputation for delivering top-tier talent consistently across various specialty areas, including Information Technology (IT), Clinical Research, Rehabilitation Therapy, and Nursing.

Position Overview

The role of the Health Plan Enrollment Analyst is crucial in managing and refining the processes that ensure all billing providers (approximately 2000) associated with our client and its affiliates are accurately credentialed and enrolled in all relevant health plans, including Medicare, Medi-Cal, and Tricare. This is essential for generating substantial revenue, estimated at around $500 million annually, in the provision of patient care.

This position entails ensuring that each billing provider meets the qualifications necessary to deliver healthcare services in alignment with our client’s policies, The Joint Commission, NCQA standards, and all applicable State and Federal regulations, including the Affordable Care Act.

Key Responsibilities
  • Collaborate with leadership at Medicare and DHCS to interpret and implement changes in regulations, assessing their impact on our client.
  • Develop and refine processes as needed to adapt to new regulatory requirements.
  • Engage with client billing agents and contracted health plans to address and resolve billing discrepancies on a daily basis.
Qualifications
  • Bachelor's degree or an equivalent combination of education and experience; a graduate degree may substitute for experience.
  • A minimum of 8-10 years of experience in a healthcare setting, particularly in provider enrollment, managed care, and health plan operations within an academic medical center or similar environment.

The incumbent will possess extensive knowledge of Federal, State, and Managed Care regulations, positioning them as a key resource in navigating the complexities of healthcare compliance.



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