Managed Care Specialist

Job Summary

To support managed care operations, the full-time Managed Care Delegation Specialist will be responsible for provider enrollment, credentialing, and delegation audit activities while working remotely with initial onsite training and occasional in-person meetings.

Key responsibilities

• Ensures providers are credentialed and enrolled in insurance plans, acting as a liaison between medical staff and payors
• Manages delegated credentialing processes and assists in contracting with managed care plans, ensuring compliance with MCO specifications
• Utilizes databases and query tools to gather data, establishing reporting and dashboards to support operations

Required qualifications

• High School diploma/GED or 10 years of relevant work experience
• Three years' experience in a medical office setting
• Experience with credentialing databases and provider relations
• Proficiency in Microsoft applications, particularly advanced Excel
• Knowledge of NCQA standards and medical staff bylaws