Health Plan Enrollment Analyst

• 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.