Managed Care Specialist

Job Summary

To support provider enrollment and managed care contracts, the full-time Managed Care Delegation Specialist will ensure credentialing and enrollment processes are followed, act as a liaison among medical staff and payors, and manage delegated credentialing activities, with a hybrid work arrangement requiring initial onsite training and occasional in-person meetings.

Key responsibilities

• Ensures providers are credentialed and enrolled in insurance plans while managing delegated credentialing processes
• Acts as a liaison between medical staff offices, credentialing verification offices, and delegation payors, staying informed on relevant bylaws and regulations
• Utilizes databases to gather data and establish reporting and dashboards that support operations, resolving reimbursement discrepancies with payors

Required qualifications

• High School diploma/GED or 10 years of relevant work experience
• Three years of experience in a medical office setting
• Proficiency in Microsoft applications, particularly advanced Excel skills
• Experience with credentialing databases and provider relations
• Knowledge of National Committee for Quality Assurance (NCQA) standards