Managed Care Enrollment Coordinator II

HCA Healthcare; Houston (TX); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Comprehensive benefits

Wellbeing support & counseling

PTO & family leave

401(k) with company match

Education assistance

Fertility & family-building benefits

Job summary

HCA Healthcare is seeking a Managed Care Enrollment Coordinator II to support the Credentialing Processing Center's enrollment and re-enrollment efforts. The role involves analyzing enrollment data, coordinating document collection, and escalating issues as needed.

Strong communication and analytical skills are essential to ensure timely, compliant processing. The position focuses on maintaining accurate hospital and payor enrollment information, supporting audits, and adhering to CPC policies

Qualifications

• Associate’s degree or equivalent work experience.
• Minimum two years of healthcare credentialing experience.
• Experience with Managed Care Enrollment and/or re-enrollment preferred.
• Knowledge of healthcare regulatory standards and laws.
• Professional telephone etiquette.
• Ability to work with minimal supervision.

Responsibilities

• Serve as Subject Matter Expert on CPC policies, procedures, and systems.
• Perform data integrity checks and compliance review functions.
• Maintain enrollment and re-enrollment processes for payor applications.
• Identify documents needing renewal before expiration dates.
• Collect required documents per CPC policies, including licenses and insurances.
• Monitor information collection and follow up on missing items.

Skills

Credentialing experience

Managed Care Enrollment

Data analysis

Communication skills

Attention to detail

Regulatory knowledge

CSMC preferred

Education

Associate degree or equivalent

Job description

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized.

Managed Care Enrollment Coordinator II

Job Summary And Qualifications

This position will support developing and implementing the Credentialing Processing Center's Managed Care Payor Enrollment and Re-enrollment. In addition, the role involves escalating expired or soon-to-be-expired required credentials. Responsibilities include analyzing and acting upon enrollment data and images of new and re-enrolled hospitals and/or other entities and maintaining information such as hospital information, ownership information, follow-up, data collection, data entry, and document review. Excellent communication and relationship-building skills are required. The role also involves researching and resolving complex situations and assisting with other tasks/projects as requested.

What you will do in this role

• Subject Matter Expert: Serve as an expert on Credentialing Processing Center policies, procedures, and systems.
• Data Integrity and Compliance Review: Perform data integrity checks, specialist review, and compliance review functions, including record preparation, final review, and flag assignment based on established CPC requirements.
• Enrollment Processes: Per policy and procedures, maintain high-quality, timely, and accurate enrollment and re-enrollment processes for all managed care payor applications.
• Document Renewal: Proactively identify documents needing renewal before expiration dates.
• Document Collection: Ensure correct information and required documents are obtained based on managed care payor requirements, policies, and procedures, including state licenses, Federal and State DEAs, liability insurance, and other required documents.
• Follow-up: Monitor the collection of all information received; follow up on missing items and/or incomplete forms per CPC Managed Care Enrollment and Re-Enrollment policies and procedures; submit follow-up requests for required documents and approval as needed.
• Issue Resolution: Identify and evaluate potential issues; collaborate with hospital leadership to document and resolve any confirmed issues.
• Policy Development: Participate in policy development and deployment.
• Audit Support: Support hospitals during managed care, payor enrollment, and re-enrollment audits.
• Issue Escalation: Advise the Manager and/or Director of questionable information received and elevate any issues identified during the processes.
• File Maintenance: Maintain all enrollment and re-enrollment files, ensuring that all correspondence in the enrollment and re-enrollment process is accurately filed; remain knowledgeable and current on the process and legal/regulatory requirements.
• Compliance: Ensure compliance with all policies and procedures, Federal and State regulatory, and accrediting agencies.
• Problem-Solving: Identifies and resolves payer enrollment issues by analyzing data, implementing corrective actions, and ensuring timely resolution to maintain compliance and operational efficiency.
• Analytical Skills: Utilizes strong analytical abilities to review enrollment data, identify patterns and trends, and generate reports that inform strategic decision-making and process improvements.
• Critical Thinking: Applies critical thinking to assess complex payer enrollment scenarios, evaluate potential impacts, and develop innovative solutions that align with organizational goals and regulatory requirements.
• Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement.”
• Perform other duties as assigned

Qualifications

• Associate’s degree or equivalent work experience.
• Minimum two years of experience in healthcare (e.g., healthcare credentialing, facility credentialing, Revenue Cycle Operations, managed care setting, credentials verification organization) required.
• Experience with Managed Care Enrollment and/or re-enrollment preferred.
• Detailed working knowledge of the healthcare and/or managed care industry, including medicallegal issues and laws, regulatory agencies, and other national standards preferred.
• Professional telephone etiquette.
• Ability to work with minimal supervision and effectively in both individual and group environments
• Certified Specialist Managed Care (CSMC) is preferred.

Benefits

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

Parallon

provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team.

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.