Provider Enrollment Analyst
Position Purpose: Reporting to the Provider Enrollment Supervisor, the Provider Enrollment Analyst manages the accurate and efficient data of SHCN providers with health plan contracts.
Coordinates all operational aspects of maintaining accurate SHCN provider data with SHCN-contracted managed care health plans working closely with other SHCN Managers, SHCN Provider Enrollment, and network representatives. Specifically, the Provider Enrollment Analyst is responsible to: manage, reconcile, and analyze SHCN provider data for accurate and continuous maintenance with SHCN and contracted health plans.
Develop close and collaborative working relationships with provider and local chapter offices to streamline the accurate submission of information to the health plans and to SHCN. Work closely with SHCN, its affiliates, and the health plans to reconcile any differences in listings of enrolled SHCN physicians. Coordinates these efforts with and through the local chapter offices and SMG Provider Enrollment and works with SHCN Analytic Team to implement changes in provider data.
Conducts ongoing audit of the process to ensure accuracy of provider data. Ensure that SHCN has an accurate and up-to-date listing of all employed and SHCN affiliated physicians at all times and that each of the contracted health plans does as well.
Identifies opportunities for improvements in the process and develops strategies to implement appropriate changes/enhancements; Develop partnerships with relevant staff at the health plans in coordinating enrollment of SHCN providers; independently troubleshooting issues as they arise.
Maintain on-going participation in cross-training activities, ensuring appropriate staff coverage of incoming volume. Actively engage in addressing special projects as they arise, conducting preliminary research and follow-up, and tracking/monitoring to facilitate on-going reporting of project status. Provides valid feedback to the Provider Enrollment Supervisor on departmental issues and progress. Perform other functions as assigned.
Education / Experience / Other Requirements
• Associates degree in a related field (or equivalent combination of education and experience).
Years of Experience:
• A minimum of 2 years of data analytics, provider/customer relations, data entry, and/or project management, preferably within a healthcare environment.
Work Related Experience:
• High proficiency in Microsoft Excel and, preferably, experience in SQL and Database management.
• Previous Managed Care and/or Medicaid experience strongly preferred.
• Ability to analyze and evaluate data and other provider related problems in order to develop alternative solutions for a positive outcome.
• Collaborative and relationship-driven style in building effective data transmissions between entities.
• Strong ability to problem solve and proven ability to learn quickly and work independently.
• Ability to multi-task and prioritize workload, manage multiple priorities, and pay meticulous attention to detail.
• Thorough understanding of managed care principles and physician practice operations, with an understanding of health plan provider enrollment and credentialing preferred.
• Excellent organizational skills, proven project management expertise; Strong verbal and written communication skills.
• Outstanding interpersonal skills, able to quickly establish a trusting rapport with individuals at all levels.
• Requisite poise, judgment, and trustworthiness to represent SHCN to internal and external groups.
• Maintains information in a confidential manner according to policy.
Job Status: Full Time
Job Reference #: 2315