Managed Care Specialist JobNorwood, OH
Why You'll Love This Job
Under direction of the Vice President, the Managed Care Specialist is responsible for supporting contracting and enrollment efforts to advance BrightView’s payer contracting processes and ensuring in-network participation with all necessary third-party payers. The candidate maintains Brightview’s organizational enrollment with Medicare, state Medicaid programs, and all managed care payers, and assists the Director of Credentialing & Payer Relations to support the Payer Enrollment team’s individual provider enrollment process. The Specialist supports BrightView’s mission to provide treatment to all patients in compliance with accreditation, government agency, and payer requirements.
Essential Job Duties:
Group Enrollments & Maintenance
- Maintain BrightView’s Medicare and Medicaid program participation in all states; including but not limited to Group NPPES maintenance, enrolling new locations and/or programs, revalidations, and Disclosure of Ownership & Controlling Interest updates.
- Complete all group credentialing applications and supporting contract documents for new locations and new payer agreements.
- Perform recredentialing of BrightView locations, and ensure changes to operations are reported according to contractual and government agency notification requirements.
- Track status of group enrollments, revalidation, and recredentialing for timely completion and reporting.
- Manage group enrollment/credentialing documents in established format and location.
- Facilitate storage of payer documents in contract management system or other centralized location, including base agreements, amendments, applicable fee schedules, and correspondence.
- Maintain internal system to ensure contractual correspondence is received timely, and as appropriate, responded to promptly, e.g., Amendment Notices, audit requests, material change notifications.
Payer & Government Program Research
- Investigate payer and government agency credentialing and enrollment requirements to support BrightView’s expansion into new states and service offerings, including coordination with Compliance to align licensure with program requirements.
- Summarize findings in established format for reference and distribution to internal stakeholders.
Department Support & Special Projects
- As requested by Vice President or Director, assist team members with special projects, e.g., payer-specific enrollment clean up, backlogs in onboarding, Credentialing Team staffing shortages, etc.
- Supports Vice President and Director with orienting new employees to the organization and the department’s functions/responsibilities.
- Identify process improvement opportunities within Managed Care and/or in collaboration with internal departments, and recommend solutions to leadership.
- Participate in external payer operations, department, and interdepartmental meetings.
- All other duties as assigned.
Skills & Qualifications
- Detail oriented, organized and possess a high degree of accuracy
- Ability to prioritize work and multi-task in a fast-paced environment
- Maintain positive working relationships with individuals at all levels of the organization, and payer representatives
- Exceptional written and verbal communication skills
- Work independently, while seeking assistance when appropriate
- Familiar with managed care concepts, billing processes, and general knowledge of compliance requirements
- Working experience with Microsoft Office, Teams and OneView/SharePoint
- Previous experience with credentialing management software and contract management systems is desired
High School Degree
Relevant college coursework or Associate’s Degree preferred
Required Work Experience:
3 years, with 1+ year in a hospital, physician practice or payer setting preferred
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Job Number: 5407