Health Plan Enrollment Analyst

On-siteMidData Analystposted 119mo ago

✦Role summaryAI-generated

This role focuses on analyzing healthcare enrollment and credentialing data to ensure compliance with federal/state regulations while optimizing provider onboarding processes for revenue integrity. The position bridges technical data analysis with regulatory interpretation to streamline operations across a $500M annual revenue cycle.

Skills required

Healthcare revenue cycle analysis Regulatory compliance analysis Credentialing process optimization Medicare medicaid data analysis Stakeholder coordination Policy procedure documentation Data validation healthcare Affordable care act compliance

About this role

This position is responsible for developing and overseeing the processes ensuring that all billing providers (approximately 2000) at Client and affiliates are appropriately and accurately credentialed and enrolled into all commercially contracted health plans, Medicare, Medi-Cal and Tricare which is required to appropriately generate revenue (approximately $500 million annually) in the course of patient care. This position ensures that each billing provider is qualified to provide health care services in accordance with Client policies and procedures, The Joint Commission and NCQA standards, commercial contracted agreements, as well as State and Federal laws and regulations including the Affordable Care Act.

This position works directly with leadership at both Medicare and DHCS to interpret changes in State and Federal regulations and the impact new regulations has on Client and develop new processes as necessary. This position works directly with Client billing agents and contracted health plans to resolve billing issues on a daily basis.

The incumbent does serve in a position of being more knowledgeable about the Federal, State and Managed Care regulations.

Qualifications

Bachelor’s degree or equivalent combination of education and experience; graduate degree can be substituted for experience.
Minimum of 8-10 years of work experience in healthcare environment with specific emphasis in provider enrollment, managed care, health plans affairs at an academic medical center and/or medical staff operations.