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Healthcare Enrollment Specialist
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Integrated Resources, Inc. is a leading staffing agency recognized for its exceptional service and integrity in the professional specialty sector since 1996. Our commitment is to deliver top-tier talent consistently across various fields, including Information Technology (IT), Clinical Research, Rehabilitation Therapy, and Nursing.
Position OverviewThe role of the Health Plan Enrollment Analyst involves the development and management of processes that ensure the accurate credentialing and enrollment of approximately 2000 billing providers at our Client and its affiliates into all contracted health plans, including Medicare, Medi-Cal, and Tricare. This is essential for generating substantial revenue, approximately $500 million annually, in patient care services.
This position is pivotal in ensuring that each billing provider meets the qualifications to deliver healthcare services in alignment with Client policies, The Joint Commission, NCQA standards, and all relevant State and Federal regulations, including the Affordable Care Act.
The Analyst will collaborate closely with leadership at both Medicare and DHCS to interpret and implement changes in regulations, assessing their impact on the Client and developing new operational processes as needed. Additionally, this role involves daily interactions with Client billing agents and contracted health plans to address and resolve billing discrepancies.
The incumbent will possess extensive knowledge of Federal, State, and Managed Care regulations, serving as a key resource in this area.
Qualifications- Bachelor's degree or an equivalent combination of education and experience; a graduate degree may substitute for experience.
- Minimum of 8-10 years of experience in a healthcare setting, with a focus on provider enrollment, managed care, and health plan operations, preferably within an academic medical center or medical staff administration.
