Sr. Enrollment and Analytics Specialist (Remote)

Quest Diagnostics; Clifton (NJ); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare company is seeking a skilled professional to manage analytics and deliverables with Health Plan and Government payers. The role involves engaging with regulatory bodies, managing provider enrollment, and ensuring compliance with industry standards. The ideal candidate will have a strong background in the Lab or Healthcare industry and possess excellent analytical and communication skills.

Qualifications

• 5+ years' relevant experience in Medicare and Medicaid provider network requirements.
• 5+ years’ experience in Lab Industry and/or Healthcare industry.

Responsibilities

• Engage with federal & state government on regulatory requirements.
• Create and manage central repository of provider application requirements.
• Develop and manage reporting for provider enrollment activities.

Skills

Analytical Skills

Communication

Process Planning

Organization

Technical Skills

Education

Bachelor's degree in business administration

Tools

Salesforce.com

Credentialing Software

Job description

Overview

Manage analytics and deliverables with Health Plan and Government payers as required by the Commercial payers, Centers of Medicare & Medicaid Services (CMS), Department of Health (DOH) for Quest Diagnostics, its subsidiaries, affiliates, and their respective testing facilities. Drive process compliance, controls and standardization utilizing a Centers of Excellence methodology to support all reporting analytics and Provider Enrollment activities.

Responsibilities

• Engage with federal & state government and third-party payers on current and future regulatory requirements
• Create and manage central repository of key reference information regarding provider application requirements
• Develop and manage reporting for provider enrollment activities
• Engage with Compliance, Legal, Laboratory Operations, Optum, Risk Management, Health Plans, and Business Development on strategic initiatives, federal and state requirements for enrollment, and other payer requests
• Create and update SOPs and playbooks to ensure that processes are aligned with the Centers of Excellence key business objectives, government, and industry standards
• Complete requests for federal & state government and third-party payers to include completion of, but not limited to, provider enrollment applications, revalidation requests, NPI enrollments, third-party payer credentialing and attestations
• Train team members on changes in enrollment requirements
• Perform Quality Assurance/Quality Control (QA/QC) on team enrollment and credentialing submissions
• Perform thorough credit evaluations to assess financial risk of customers, ensuring compliance with company’s credit policies and guidelines
• Distribute monthly rosters of patient-facing facilities to ensure accuracy in various third-party payer directories
• Govern and distribute a catalogue of all testing facilities for the purpose of internal analytics that is used for contract negotiations and engagement with third-party payers
• Manage the updates of the online registry for commercial payers including their contractual status with Quest Diagnostics, its subsidiaries, and affiliates

Qualifications

Education:

• Bachelor's degree in business administration (preferred), Certification or equivalent

Required WorkExperience:

• 5+ years' relevant experience, including working knowledge of Medicare and Medicaid provider network requirements, enrollment, or third-party payer credentialing
• 5+ years’ experience in Lab Industry and/or Healthcare industry and a comprehensive understanding of highly matrixed organizational structures

Preferred Work Experience:

• Work experience in Provider Enrollment and Credentialing including understanding of state regulatory requirements for Enrollment submission

Knowledge:

• Medicare Provider Enrollment, Chain, Ownership System (PECOS)
• State Medicaid Web Portals
• Council for Affordable Quality Healthcare (CAQH) Provider Daily Portal
• National Plan and Provider Enumeration System (NPPES)
• Salesforce.com or comparable CRM Tool
• Credentialing Software

Skills:

• Strong analytical and critical thinking skills
• Strong written and verbal communication
• Process planning and organization
• Strong technical skills in MS Word and Excel
• Able to multi-task and perform in a fast-paced environment

EEO

Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets or any other legally protected status.