Healthcare Enrollment Specialist

2 weeks ago


MI United States McLaren USA Full time
Job Summary:

As a key member of the McLaren Health Care system, the Enrollment Specialist will play a vital role in maintaining and updating the initial credentialing and/or re-credentialing of providers or facilities with third-party payers and institutional enrollment requirements for governmental programs. This position requires strong collaboration with each facility or appropriate McLaren department to obtain supporting documentation and information required to meet payers' regulatory and compliance requirements for their credentialing and enrollment programs.

Key Responsibilities:

1. Prepare and maintain requests for initial credentialing and re-credentialing for facilities or providers, ensuring timely submission to meet regulatory requirements.

2. Facilitate and coordinate with appropriate McLaren departments to ensure supporting documents are obtained for completion of initial and re-credentialing applications, streamlining the process for efficient enrollment.

3. Stay up-to-date with third-party and governmental payers' regulations and changes pertaining to credentialing and enrollment, applying this knowledge to ensure compliance and effective enrollment processes.

4. Collaborate with McLaren Physician Partners and related entities to manage credentialing applications, contracted health plan inquiries, and information requests, fostering strong relationships and efficient communication.

5. Utilize external databases and payer portals to complete information needed for submission and update information as necessary, ensuring accuracy and efficiency in the enrollment process.

6. Support vendors for out-of-state Medicaid claims by collecting supporting documentation and signatures required, if applicable, ensuring seamless enrollment processes.

7. Maintain an enrollment worklist, putting claims on hold until providers are credentialed by the payer, and then releasing claims on hold once providers are enrolled with the payer, if applicable, ensuring timely and accurate enrollment.

8. Effectively communicate project status, including barriers encountered, to allocate resources and ensure successful enrollment outcomes.

9. Communicate with appropriate McLaren Health Care system divisions relative to enrollment and credentialing, fostering collaboration and ensuring alignment with organizational goals.

Requirements:

Required:
  • High school diploma or GED
  • Two years or more experience in a role related to healthcare administration pertaining to insurance payors and provider relations


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