Managed Care Payer Enrollment Specialist

1 month ago


Morgantown, West Virginia, United States Mon Health Full time
Job Summary

We are seeking a highly skilled Managed Care/Payer Enrollment Specialist to join our team at Mon Health. This role will be responsible for managing daily activities related to providing operational support for Payer Enrollment.

Key Responsibilities
  • Manage accounting and information systems in support of Managed Care/Payer Enrollment
  • Develop strategies for improving levels of reimbursement under managed care agreements
  • Develop and guide organizational structure and processes necessary to support managed care agreements
  • Work directly with Managed Care Organizations to resolve enrollment and administrative escalations occurring with Managed Care contracts
Requirements
  • High school diploma or equivalent required; Bachelor's degree preferred
  • One to three years of current provider credentialing experience required; previous Hospital Credentialing experience required
  • Basic to working knowledge of Centers for Medicaid and Medicare and Managed Care concepts, including Managed Medicare/Medicaid requirements, Disclosure of Ownership and Control Interest, and applicable laws/statutes/regulations
  • Previous experience working with hospital contracts or demonstrated knowledge of contract principles and interpretation of contract language
  • Certified Provider Credentialing Specialist (CPCS) certificate preferred or willingness to sit for CPCS within one (1) year of hire


  • Morgantown, West Virginia, United States Mon Health Full time

    Key Responsibilities:The Managed Care/Payer Enrollment Specialist at Mon Health will be responsible for managing daily activities related to providing operational support for Payer Enrollment.This role involves managing accounting and information systems in support of Managed Care/Payer Enrollment and developing strategies for improving levels of...


  • Morgantown, West Virginia, United States West Virginia University Hospitals, Inc. Full time

    We are seeking a highly skilled Care Management Assistant to join our team at West Virginia University Hospitals, Inc. The successful candidate will provide support to the Care Management Team to ensure the day-to-day operational functions of the department are met in a timely manner.This role involves collaboration with third-party payers and post-acute...


  • Morgantown, West Virginia, United States West Virginia University Hospitals, Inc. Full time

    Care Management Assistant Job SummaryWe are seeking a highly skilled and detail-oriented Care Management Assistant to join our team at West Virginia University Hospitals, Inc. The successful candidate will provide administrative support to the Care Management Team, ensuring the day-to-day operational functions of the department are met in a timely manner.Key...


  • Morgantown, West Virginia, United States WVU Medicine Full time

    Care Management Assistant Job DescriptionWe are seeking a highly organized and detail-oriented Care Management Assistant to join our team at WVU Medicine. In this role, you will provide administrative support to the Care Management Team, ensuring the day-to-day operational functions of the department are met in a timely manner.Key...


  • Morgantown, West Virginia, United States West Virginia University Hospital, Inc Full time

    Care Management Assistant Job DescriptionWe are seeking a highly skilled and dedicated Care Management Assistant to join our team at West Virginia University Hospitals. As a Care Management Assistant, you will play a vital role in ensuring the day-to-day operational functions of the Care Management department are met in a timely manner.Key...


  • Morgantown, West Virginia, United States WVUHS Home Care, LLC Full time

    Job Title: LPN Home Health Care SpecialistWe are seeking a skilled LPN Home Health Care Specialist to join our team at WVUHS Home Care, LLC. As a key member of our home health care team, you will provide high-quality nursing care to patients in their homes, working collaboratively with our multidisciplinary team to ensure the best possible...


  • Morgantown, West Virginia, United States CAMC Health System Full time

    Job SummaryThe Clinical Care Specialist will provide comprehensive management of patients within their given specialty and according to privileges approved by the Medical Staff office. The specialist has responsibility, authority, and accountability for the provision of care through collaboration with a physician. The specialist manages and provides patient...

  • Wound Care Specialist

    4 weeks ago


    Morgantown, West Virginia, United States West Virginia University Hospital, Inc Full time

    Welcome to the Wound Care Specialist position at West Virginia University Hospitals, where we are committed to providing exceptional patient care and service. As a key member of our team, you will play a vital role in delivering high-quality wound care to our patients.Job Summary:The Wound Care Specialist will provide comprehensive wound management services...


  • Morgantown, West Virginia, United States WEST VIRGINIA UNIVERSITY RESEARCH CORPORATION Full time

    About the OpportunityThe West Virginia University Research Corporation is seeking a highly skilled Community Support Specialist to join our team. As a Community Support Specialist, you will play a critical role in providing support for the Mentoring & Oversight for Developing Independence with Foster Youth (MODIFY) Program at the WVU Center for Excellence in...


  • Morgantown, West Virginia, United States Aequor Technologies Full time

    Job Title: Clinical Care SpecialistJob Summary: We are seeking a skilled Clinical Care Specialist to join our team at Aequor Technologies. As a Clinical Care Specialist, you will be responsible for providing high-quality patient care in a fast-paced environment.Key Responsibilities:Provide direct patient care to pediatric patients in the intensive care...


  • Morgantown, West Virginia, United States WVU Medicine Full time

    OverviewWelcome to WVU Medicine, a leading healthcare organization in West Virginia. We are currently seeking a highly skilled Faculty Onboarding Specialist to join our team.Job DescriptionThis is an exciting opportunity to work as the primary individual responsible for onboarding and integration activities of new clinical faculty at WVU Medicine. The...


  • Morgantown, West Virginia, United States Host Healthcare Full time

    Job Title: Pediatric Care SpecialistJob Summary: We are seeking a skilled Pediatric Care Specialist to join our team at Host Healthcare. As a Pediatric Care Specialist, you will provide high-quality patient care in a dynamic and fast-paced environment.Responsibilities:Provide direct patient care to pediatric patients in a progressive care unit...

  • Nurse Specialist

    4 weeks ago


    Morgantown, West Virginia, United States Care Team Solutions Full time

    We're seeking a skilled Oncology Care Professional to join our team at Care Team Solutions. As a Nurse Specialist, you'll provide top-notch care to patients with cancer and related conditions.Key Responsibilities:Deliver high-quality patient care in an Oncology settingCollaborate with healthcare teams to develop and implement patient care plansProvide...

  • Pet Care Specialist

    4 weeks ago


    Morgantown, West Virginia, United States Petco Animal Supplies Stores, Inc Full time

    Petco Animal Supplies, Inc. is a leading health and wellness company focused on improving the lives of pets, pet parents, and our planet.We are seeking a highly motivated and knowledgeable Pet Care Specialist to join our team. As a Pet Care Specialist, you will be responsible for providing exceptional customer service, assisting guests with their pet-related...


  • Morgantown, West Virginia, United States TotalMed Staffing Full time

    Job Title: Critical Care Nurse SpecialistAbout the Role:As a Critical Care Nurse Specialist, you will provide high-level care to critically ill patients in the ICU setting. Collaborate with a multidisciplinary team to develop and implement individualized care plans.Responsibilities:• Provide specialized nursing care to critically ill patients in the...


  • Morgantown, West Virginia, United States TotalMed Staffing Full time

    Job Title: Critical Care Nurse SpecialistAbout the Role:As a Critical Care Nurse Specialist, you will provide high-quality patient care in the Intensive Care Unit (ICU) setting. Collaborate with a multidisciplinary team to develop and implement individualized care plans for critically ill patients.Responsibilities:Assess patients' conditions, monitor vital...

  • Nurse Care Specialist

    2 weeks ago


    Morgantown, West Virginia, United States Mon Health Medical Center Full time

    About Mon Health Medical CenterWe are a leading healthcare provider in the region, committed to delivering exceptional patient care and improving the health of our community.Job Title: Nurse Care Specialist - NightsThe estimated salary for this position is $120,000 per year.Job DescriptionAs a Nurse Care Specialist at Mon Health Medical Center, you will play...


  • Morgantown, West Virginia, United States West Virginia University Hospital, Inc Full time

    Job SummaryWe are seeking a highly skilled Pharmacy Business Coordinator to join our team at West Virginia University Hospitals. The successful candidate will be responsible for conducting payer discussions, in-house financial audits, and ensuring compliance with revenue cycle operations, third-party reimbursement procedures, and regulations.Key...


  • Morgantown, West Virginia, United States West Virginia University Full time

    Job Summary:We are seeking a highly motivated and detail-oriented Agricultural Technician to join our team at West Virginia University's Davis College of Agriculture, Natural Resources and Design. The successful candidate will be responsible for providing quality care and maintenance of animals, crops, equipment, and physical facilities used in routine...


  • Morgantown, West Virginia, United States Mon Health Full time

    As a Vascular Surgical Care Specialist at Mon Health, you will play a critical role in the comprehensive care of our vascular surgical patients. This position requires a high level of expertise and collaboration with patients, families, physicians, and healthcare services.Key responsibilities include evaluating and assessing vascular surgical patients,...