Provider Enrollment Liaison
• Reporting to the Credentialing & Provider Enrollment Director, the Provider Enrollment Liaison coordinates the accurate and efficient enrollment of SHCN providers into health plan contracts.
• Coordinates all operational aspects of enrolling SHCN physicians into SHCN-contracted managed care health plans working closely with other SHCN Managers, SHCN Provider Enrollment, and network representatives. Specifically, the Provider Enrollment Liaison is responsible to: Coordinate the full cycle Provider Enrollment function for SHCN, across the entire physician network.
• Develop close and collaborative working relationships with provider and PO 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 PO 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 Director 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:
• Three to five years administrative experience, preferably within a healthcare environment.
Work Related Experience:
• Familiarity with Microsoft Office software (Word, Access, Excel, PowerPoint)
• Previous Managed Care and/or Medicaid experience strongly preferred.
• 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 #: 8659