Senior Managed Care Specialist-(PROVIDER ENROLLMENT)

St. Jude Children's Research Hospital, Inc.; United States; Hybrid; USD 40,000 - 69,000; Full time

Job summary

St. Jude Children's Research Hospital in the United States is seeking a Senior Managed Care Specialist focused on Provider Enrollment to manage enrollment and credentialing for hospital-employed or contracted physicians across insurance programs.

The role requires at least 4 years in healthcare settings, experience with managed care contracts, EPIC or CredentialStream, and strong collaboration with internal teams.

Qualifications

• 4+ years of experience in healthcare, academic or research settings.
• Experience in healthcare office environment with understanding of managed care contracts.
• Experience managing enrollment and credentialing in a timely manner.
• Familiarity with payer communications and guidelines.

Responsibilities

• Independently execute and manage managed care tasks within own area of responsibility (e.g., provider enrollment and credentialing, claims, payor issues).
• Work closely with internal and external teams to coordinate information and resolve issues.
• Support payer communications efforts and other documentation.
• Manage denial issues related to contractual, enrollment or credentialing issues in a timely manner; monitor delivery for compliance.
• Perform other duties as assigned to meet department goals and institution.
• Maintains regular and predictable attendance.

Skills

Provider enrollment

Credentialing

Claims processing

Payor issues resolution

Education

High school diploma/GED

Tools

EPIC

CredentialStream

Job description

The Senior Managed Care Specialist - PROVIDER ENROLLMENT is responsible for managing provider enrollment duties and tasks, implementing and maintaining all data and activities related to the enrollment of hospital employed or contracted physicians into all contracted insurance programs, including State Medicaid programs. Their primary goal is to ensure efficient and cost-effective healthcare delivery while maintaining high-quality standards. This position requires minimum of 2 days/week onsite

Job Responsibilities:

• Independently execute and manage managed care tasks within own area of responsibility (e.g., provider enrollment and credentialing, claims, payor issues).
• Work closely with internal and external teams (e.g., clients, customers) to coordinate, clarify information, and resolve issues.
• Support payer communications efforts (e.g., new publications, guidelines) and other supportive documentation.
• Manage denial issues related to contractual, enrollment or credentialing issues in a timely manner; monitor own delivery for compliance with overall guidelines, policies & procedures.
• Perform other duties as assigned to meet the goals and objectives of the department and institution.
• Maintains regular and predictable attendance.

Minimum Education and/or Training:

High school diploma/GED required.

Minimum Experience:

• Minimum Requirement: 4+ years of experience in a healthcare, academic or research setting.
• Experience in healthcare office environment with some understanding of managed care contract and reimbursement models.
• Manage denial issues related to contractual, enrollment or credentialing issues in a timely manner; monitor own delivery for compliance with overall guidelines, policies & procedures.
• Proven performance in earlier role.
• Experience with EPIC and CREDENTIALSTREAM preferred.
• Prior PROVIDER ENROLLMENT experience is strongly preferred.

Compensation

In recognition of certain U.S. state and municipal pay transparency laws, St. Jude is including a reasonable estimate of the compensation range for this role. This is an estimate offered in good faith and a specific salary offer takes into account factors that are considered in making compensation decisions including but not limited to skill sets, experience and training, licensure and certifications, and other business and organizational needs. It is not typical for an individual to be hired at or near the top of the salary range and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current salary range is $29.00 - $50.50 per hour for the role of Senior Managed Care Specialist-(PROVIDER ENROLLMENT).

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