Manager of Payor Contracting and Provider Enrollment
Posted on: November 22, 2021
Manager of Payor Contracting and Provider Enrollment This
position is with a national specialty physician group based in the
Phoenix area. The Manager of Payor Contracting and Provider
Enrollment will lead a team of people who support the intake and
enrollment of new providers in health plans. This position will
also provide a knowledgebase to the entire team with regard to
networks, health plan products, and health plan coverage details.
This role will report to an RCM Director with 6 direct reports
current. This number is expecting to double over the next year.
- Manages department---s work queues and productivity reports to
ensure timely submission of charges.
- Serves as the initial point of contact to establish health plan
contracts in various markets.
- Negotiates contract terms with health plans and brings proposal
to executive level for final approval and signature.
- Facilitates dispute resolution involving claims and
reimbursement issues between Revenue Cycle Management and health
- Maintains an accurate inventory of healthcare individual
providers, groups, and locations in the database that feeds the
credentialing and provider enrollment process.
- Identifies providers who are contracted with various health
plan products in a manner that is easy for users to
- Oversees the necessary steps to credential providers, as well
as, performs routine periodic checks of various databases to assure
integrity of the provider inventory.
- Oversees the necessary steps to enroll providers in health plan
products as needed.
- Serves as project coordinator and information exchange for data
requests that come into the Revenue Cycle Management service area,
assuring that data requests are being completed.
- Performs other related duties as assigned or needed for
- Serves as subject matter expert on:
- Health plan architecture, product offerings, network
restrictions, authorization, referral, and other components of the
health plan marketplace.
- Medicare Choice and Medicaid managed care plans in national
- Health plan verification of benefits and coverage. Job
- Bachelor---s Degree preferred.
- Knowledge and experience with provider enrollment,
credentialing and contracting.
- Knowledge and experience with health plan markets.
- Knowledge and experience with health plan products.
- Knowledge and experience with health plan benefits.
- Detail oriented, professional attitude, and reliable.
- Proficiency with Microsoft Office Suite.
- Possess strong organizational and time management skills.
- Ability to interact with all internal and external customers in
a professional manner.
- Ability to communicate effectively both verbally and in
- Ability to manage multiple priorities successfully and drive
- Ability to define, analyze and resolve issues quickly and
- Demonstrated leadership ability. --
Keywords: hireneXus, Tempe , Manager of Payor Contracting and Provider Enrollment, Executive , Tempe, Arizona
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