Special Enrollments Supervisor – PSA Opt 1

Jobtailor; Springfield (IL); On-site; USD 80,000 - 110,000; Full time

Job summary

Jobtailor in the United States (Illinois) seeks a supervisor-level professional to lead the Special Enrollments Unit. The role focuses on provider enrollment, credentialing, and database oversight within a large medical health plan context.

Responsibilities include policy interpretation, data element enhancements for provider databases, and ensuring compliance with state and federal mandates. Strong leadership and data management skills are essential.

Qualifications

• Four-year college degree or equivalent.
• Three years of administrative experience in public or business organizations.
• Three years of provider enrollment/credentialing experience.
• Three years of experience with MMIS, provider databases, or data warehouses.
• Ability to use state-issued equipment (laptop).
• Background check and disclosure of criminal history.
• Authorized to work in the United States full-time.

Responsibilities

• Plan, direct, and evaluate the Special Enrollments Unit for the Bureau.
• Serve as a working supervisor.
• Develop and review studies to implement new data elements for the Provider Database.
• Interpret Medicaid policies for staff, the medical community, and other agencies.
• Organize and manage Provider Database records for new providers.

Skills

Provider Enrollment

Medicaid Policy Interpretation

Database Management

Administrative Experience

Staff Supervision

Education

Four-year college degree

Tools

MMIS

Provider Database

Data Warehouse Database

Job description

• Plan, direct, and evaluate the Special Enrollments Unit for the Bureau
• Serve as a working supervisor
• Develop, direct, and review management studies identifying and implementing new data elements for the Provider Database
• Interpret Medicaid policies and other agency incentive programs for Department staff, officials, the medical community, and other agencies
• Organize, direct, and manage Provider Database records for newly approved providers
• Implement processes to terminate or suspend providers convicted or found guilty of fraudulent Medicaid billing
• Serve as backup to the Provider Enrollment Services unit supervisor
• Perform other duties reasonably within the scope of the position
• Report under the direction of the Bureau Chief and Provider Enrollment Services Manager

Requirements

• Knowledge, skill, and mental development equivalent to completion of four (4) years of college
• Prior experience equivalent to three (3) years of progressively responsible administrative experience in a public or business organization
• Three (3) years of professional experience in provider enrollment, credentialing providers into a large medical health plan
• Three (3) years of experience with applications such as Medicaid Management Information System (MMIS) databases, provider database, payee database or data warehouse database, including maintenance and upgrades
• Ability to utilize and maintain state issued equipment such as a laptop
• Completion of a background check and self-disclosure of criminal history
• Currently authorized to work in the United States on a full-time basis
• Ability to work Monday-Friday, 8:30 am-5:00 pm
• Preferred: Minimum of three (3) years of experience interpreting Medicaid policies to ensure compliance with state and federal mandates and guidelines
• Preferred: Minimum of two (2) years of professional experience utilizing public or business administration principles and practices
• Preferred: Minimum of two (2) years of experience supervising staff, providing employment motivation and development

Core Competencies

Demonstrates expertise in provider enrollment and credentialing within large medical health plans, with a strong understanding of Medicaid policies and compliance. Proven ability to manage databases and implement processes for provider oversight and fraud prevention.

Highest-signal resume keywords

• Provider Enrollment
• Medicaid Policy Interpretation
• Database Management
• Administrative Experience
• Staff Supervision

ATS Optimization Keywords

Hard Skills

• Provider Credentialing
• Data Management
• Fraud Prevention ProcessesAdministrative Procedures
• Compliance Monitoring

Soft Skills

• Leadership
• Organizational Skills
• Communication

Industry Keywords

• Public Administration
• Healthcare Compliance
• Fraudulent Billing
• State and Federal Mandates

Tools & Technologies

• Medicaid Management Information System (MMIS)
• Provider Database
• Data Warehouse Database