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Healthcare Enrollment Specialist
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Integrated Resources, Inc. is a leading staffing agency known for its exceptional service and integrity since 1996. Our commitment is to deliver top-tier talent consistently across various sectors, 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 accurate credentialing and enrollment of approximately 2000 billing providers within our organization and its affiliates. This is crucial for generating significant revenue in patient care.
The analyst will ensure that each billing provider meets the necessary qualifications to deliver healthcare services, adhering to our internal policies, The Joint Commission standards, NCQA guidelines, and all relevant 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.
- Develop new processes in response to regulatory updates.
- Work closely with billing agents and 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.
- 8-10 years of experience in a healthcare setting, particularly in provider enrollment and managed care operations.
