Managed Care Coordination Specialist

Job Summary

A company is looking for a Sr. Managed Care Coordination Specialist.

Key Responsibilities

• Lead the preparation and submission of provider rosters to Managed Medicare, Medicaid, and commercial payers
• Audit internal provider data against database records to ensure accuracy before submission
• Serve as the primary point of contact for health plans to resolve roster discrepancies and maintain compliance

Required Qualifications

• 5+ years in healthcare credentialing, provider enrollment, or managed care analysis
• Advanced Excel proficiency, including VLOOKUPs and pivot tables
• Familiarity with credentialing databases and experience in CredentialStream preferred
• Deep understanding of CAQH, NPI, Availity, and the provider enrollment lifecycle
• CPMSM, CPCS, or CPES certification through NAMSS preferred