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As a Payor Enrollment Specialist at MedStar Corporate Managed Care, you will play a critical role in facilitating provider enrollment and managed care insurance credentialing/re-credentialing processes to ensure timely enrollment in payor panels on behalf of MedStar hospitals and MedStar Ambulatory Medical Groups.

• Facilitate provider enrollment and managed care insurance credentialing/re-credentialing processes to ensure compliance with regulatory requirements and payor guidelines.
• Build and maintain positive relationships with managed care insurance/payors to ensure seamless credentialing and enrollment processes.
• Coordinate, monitor, and maintain the credentialing/re-credentialing of all practitioners employed and/or contracted for commercial and MCO payors, ensuring accuracy and integrity of the credentialing database.
• Obtain necessary approvals and signatures, verify documentation, and submit timely credentialing packets to payors.
• Follow up with managed care organizations regarding credentialing status and provider numbers, resolving any issues or concerns in a timely manner.
• Maintain the accuracy and integrity of the credentialing database, ensuring that all practitioner information is up-to-date and compliant with regulatory requirements.
• Handle requests for additional information from managed care organizations and identify and respond to issues and concerns regarding practitioner setup, ensuring that all necessary documentation is complete and accurate.
• Notify managed care organizations of provider changes and provide follow-up to confirm changes have been made, ensuring seamless credentialing and enrollment processes.
• Generate and distribute provider number reports upon request, providing valuable insights to stakeholders.
• Track and monitor the credentialing/re-credentialing process of managed care organizations, working closely with these payors to expedite the credentialing/credentialing process and resolve any issues or concerns.
• Work closely with internal finance and service line customers along with internal/external billing groups to resolve credentialing and outstanding Accounts Receivable/revenue issues, ensuring that all financial transactions are accurate and compliant with regulatory requirements.
• Work directly with practitioners, service line leaders, practice administrators, and hospital executives to initiate the credentialing/re-credentialing process, ensuring that all necessary documentation is complete and accurate.
• Participate in meetings and on committees, representing the department and hospital in community outreach efforts and ensuring that all stakeholders are informed and engaged.

• Bachelor's degree in business or a related healthcare discipline, such as healthcare administration or health information management.
• 5-7 years of healthcare experience in managed care credentialing, payor relations, and physician relations, with a strong understanding of regulatory requirements and payor guidelines.
• Experience with practitioner credentialing process and completing managed care credentialing applications, with a strong attention to detail and ability to analyze and evaluate data.
• Customer service and managed care contract experience, with a strong ability to build and maintain positive relationships with managed care insurance/payors.
• Excellent verbal and written communication skills, with the ability to communicate complex information in a clear and concise manner.
• Strong organizational, interpersonal, and critical thinking skills, with the ability to work independently with minimum supervision and prioritize multiple tasks and projects.
• Ability to analyze and evaluate data and other provider-related problems and develop alternative solutions, ensuring that all stakeholders are informed and engaged.
• Proficient in Microsoft Office software programs (Word, Excel, and PowerPoint), with experience with credentialing software a plus.

MedStar Corporate Managed Care is a leading healthcare organization dedicated to providing high-quality care to our patients. We are committed to excellence in all aspects of our operations and strive to create a positive and supportive work environment for our employees.