Medicaid Enrollment Specialist

This role reports to the VP Payer Strategies and has no direct reports. The Medicaid Enrollment Specialist is responsible for initiating and troubleshooting Group and Provider Medicaid Enrollments, supporting Provider Enrollment Colleagues in assigned markets, and supporting the full and functional implementation of CredentialStream.

Key Responsibilities:

Medicaid Enrollment

· Compiles, completes, and manages initial Medicaid Enrollments and revalidations in assigned markets.

· Manages Gainwell portal access for Credentialing Colleagues and CareCloud Colleagues, including ERA/EFT enrollment and Trading Partner access.

· Supports Provider Enrollment with Medicaid MCOs and Commercial payers, as directed.

· Troubleshoots ad hoc Medicaid Enrollment issues, as directed.

· Maintains accurate and organized Medicaid Enrollment records in the P drive, Payer Grids, and Trackers.

· Communicates with Stakeholders regarding Medicaid Enrollment status, required credentials, and follow-up needs.

· Stays up-to-date with regulatory changes impacting credentialing.

· Supports process improvements and maintains confidentiality of all Provider and organizational information.

· Actively participates in group meetings presenting Medicaid enrollment status for assigned territories.

· Other duties as assigned.

CredentialStream

· Completes CredentialStream trainings, as assigned.

· Accomplishes configuration of the Provider Enrollment modules to support roster creation, enrollment with payers, and tracking of provider participation with payers.

Requirements:

· High school diploma or equivalent, required. Associate's or Bachelor's degree, preferred.

· Three years of experience in Provider Enrollment for physician practices and/or Managed Care Insurance Enrollment, Medicare, Medicaid, and Medicaid MCOs, preferred.

· Ability to communicate and solve problems effectively with a Provider Service Orientation.

· Ability to organize and prioritize individual work and special projects while fostering a culture of cooperation, unity, and positive intent.

· Ability to maintain confidentiality when dealing with organizational, departmental, and staff issues.

· Proficiency in Gainwell provider enrollment portals and credentialing databases, required. Working knowledge of PECOS/NPPES, Commercial payer portals, and CAQH, preferred.

· Knowledge of payer credentialing processes, ability to organize and prioritize work, and effectively manage multiple priorities.

· Excellent verbal and written communication skills.

· Excellent soft skills and ability to handle all interactions with diplomacy and tact.

· Ability to research and analyze data, work independently, and establish and maintain effective working relationships.

· Proficient computer skills – Adobe, Microsoft Office, Excel, Word, and use of data management systems.

· Knowledge of payer operating procedures and practices.

· Strong attention to detail.

Job Type: Full-time

Pay: $46, $48,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending