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Managed Care Provider Enrollment Specialist

Employer
Stony Brook University
Location
Stony Brook, NY

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Administrative Jobs
Institutional & Business Affairs, Admissions & Enrollment
Employment Type
Full Time
Institution Type
Four-Year Institution
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Job Details

DescriptionSB Med Logo


Position Summary


The Managed Care Provider Enrollment Specialistis responsible for ensuring the enrollment and continuity of the clinicalhealth care providers who are affiliated with Stony Brook Medicine, including the physicians of the clinical specialties administered by the ClinicalPractice Management Plan, Meeting House Lane Medical Practice, PC and theclinically integrated networks participation with managed care organizationsand other payers by managing the enrollment process and timely submission ofrequired documents. The incumbent is responsible for enrollment, disenrollmentand demographic changes with contracted managed care organizations,coordinating and maintaining documents required to enroll a provider with themanaged care organization and internal and external audits and correctiveaction plans as it relates to provider demographic information. 



Duties of the Managed Care Provider Enrollment Specialist  may include the following but are not limited to:

  • Responsible for the dataintake, collection and accuracy of individual clinical health care providerdemographic data and supporting documentation required to enroll provider in amanaged care organization network. Once a network provider, ensure continuityof the clinical health care provider by submitting demographic data orsupporting documentation. Notifies managed care organization and other payersof practice location changes, phone and other licensure or certificationchanges, inaccurate information in managed care organization or other payerssystems and directories.
  • Via delegated credentialingelectronic roster or other format, transmit information, data and documentationto managed care organizations and other payers withinestablished guidelines for turnaround time and in accordance with departmentpolicies and procedures and external requirements (delegated agreement, federalor state). 
  • Coordinates timelyenrollment and transaction activities and communication with centraldepartments and sites to ensure consistency and accuracy. Follow-up withmanaged care organization or other payer representative to facilitate promptcompletion of enrollment. Handles enrollment issues and exceptions and resolvesissues. Escalate to supervisor when needed.
  • As it relates to theDelegated Credentialing Agreement, maintain tracking logs and monitor thestatus of managed care organization or other payer for compliance. Informsupervisor of non-compliance.
  • Establish and/or maintainelectronic provider enrollment database(s) for assigned clinical practices. Supportdata integrity through analyzing and auditing demographic data. If deficienciesfound, work with appropriate team members to update erroneous data. Routinely distributeprovider enrollment database(s) to Stony Brook Medicine,including the physicians of the clinical specialties administered by theClinical Practice Management Plan, Meeting House Lane Medical Practice, PC, theclinically integrated network andother interested constituents.
  • Respond to inquiries frominsurance plans and internal team members.
  • Attend required meetingsand participates in training programs as required; participates in a variety ofprofessional activities.
  • Keep accurate communicationrecords of contacts and verifying agencieswithin the department.
  • Develop and distribute notifications to internalteam members.
  • Maintain current knowledge of NCQA, TJC, CMS and State Laws and regulations as theypertain to credentialing.
  • Other duties as assigned. 


    • Qualifications


    Required Qualifications: Associate's degree and at least three (3) years of direct experience in enrolling clinical healthcare providers either within a health care delivery organization or group ofmoderate or significant size or on behalf of a managed care organization orpayer. Knowledge of NCQA, TJC, CMS and State Laws andregulations as they pertain to credentialing. Ability to work independently. Possess organizational skills. Excellent written and verbal communication skills, interpersonal skills, time management skills, critical thinking skills, problem solving skills, and project management skills. 

     

    Preferred Qualifications: Bachelor's degree and three (3) or more years of direct experience in enrolling clinical health care providers eitherwithin a health care delivery organization or group of moderate or significantsize or on behalf of a managed care organization or payer. Exercise independent judgement in interpreting NCQA,TJC, CMS and State Laws and regulations as they pertain to credentialing. Experience with CACTUS or similar databasesoftware and Microsoft Office Suite. 



    Special Notes: 
    This position will remain posted until filled or for 90 days max.
    An initial review of all applicants will occur two weeks from the posting date. For full consideration, applications must be received before the initial review date (Which is within two weeks of the posting date). If within the initial review no candidate was selected to fill the position posted, additional applications will be considered for the posted position; however, the posting will close once a finalist is identified, and at minimal, two weeks after the initial posting date.  
    Please note, that if no candidate was identified and hired within 90 days from initial posting, the posting would close for review, and possibly reported at a later date.

    Stony Brook Medicine is a smoke free environment. Smoking is strictly prohibited anywhere on campus, including parking lots and outdoor areas on the premises. All Hospital positions are subject to changes in pass days and shifts as necessary.  This position may require the wearing of respiratory protection, which may prohibit the wearing of facial hair.
    The selected candidate must successfully clear a background investigation. Prior to start date, the selected candidate must meet the following requirements: Successfully complete pre-employment physical examination and obtain medical clearance from Stony Brook Medicine's Employee Health Services (The hiring department will be responsible for any fee incurred for examination), submit (3) written references, and provide a copy of any required New York State license(s)/certificate(s). Please be advised that failure to comply with any of the above requirements could result in a delayed start date and/or revocation of the employment offer.


    About Stony Brook Medicine:


    The best ideas in medicine start with the best people. At Stony Brook Medicine, our highest calling is to put the power of ideas to work in our patients’ lives. Stony Brook Medicine integrates and elevates all of our health-related initiatives: education, research and patient care. Stony Brook Medicine is Long Island’s premier academic medical center. With 603 beds, we serve as the region’s only tertiary care center and Level 1 Trauma Center, and are home to the Stony Brook Heart Institute, Stony Brook Cancer Center, Stony Brook Children’s Hospital, Stony Brook Neurosciences Institute, and Stony Brook Digestive Disorders Institute. We also encompass Suffolk County’s only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation’s first Pediatric Multiple Sclerosis Center.

     

    Stony Brook University is an Affirmative Action/Equal Opportunity employer. We are committed to the creation of a diverse and inclusive campus climate. We encourage protected veterans, individuals with disabilities, women and minorities to apply.


    This function/position has been designated as “essential.” This means that when the Hospital is faced with an institutional emergency, employees in such positions may be required to remain at their work location or to report to work to protect, recover, and continue operations at Stony Brook Medicine, Stony Brook University Hospital and related facilities.

     

    Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation.  If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at info@goer.ny.gov.


    IF YOU NEED A DISABILITY-RELATED ACCOMMODATION, PLEASE CALL THE UNIVERSITY HUMAN RESOURCE SERVICES DEPARTMENT AT (631) 632-6161 OR THE UNIVERSITY HOSPITAL HUMAN RESOURCES DEPARTMENT AT (631) 444-4700.
    IN ACCORDANCE WITH THE TITLE II CRIME AWARENESS AND SECURITY ACT, A COPY OF OUR CRIME STATISTICS IS AVAILABLE UPON REQUEST BY CALLING (631) 632-6350. IT CAN ALSO BE VIEWED ON-LINE AT THE UNIVERSITY POLICE WEBSITE AT http://www.stonybrook.edu/police



    Job Field: Administrative & Professional (non-Clinical)
    Primary Location: US-NY-Stony Brook
    Schedule: Full-time
    Shift: Day Shift
    Posting Start Date: Aug 7, 2019
    Posting End Date: Nov 5, 2019, 11:59:00 PM

    Organization

    In a little more than 50 years, Stony Brook has established itself as one of America’s most dynamic public universities, an essential part of the region’s economy, and a center of cultural excellence.

    Nobel laureates, Guggenheim fellows, and MacArthur grant winners teach on our campus, making it a magnet for outstanding students. Stony Brook has been ranked in the top 1 percent of all universities worldwide by the stonyLondon Times Higher Education—QS World University Rankings. U.S. News & World Report ranks Stony Brook among the top 100 best national universities. A member of the elite Association of American Universities, Stony Brook is among the 62 best research institutions in North America. Stony Brook faculty are leaders in significant national and worldwide projects, including the reconstruction of Iraq’s public health systems and museums, the management of the national parks of Madagascar,

     

    and uncovering the causes of lobster mortality in Long Island Sound.

    The entrepreneurial energy and economic strength of the University bring a combined benefit of $4.7 billion to the economy of Long Island. Stony Brook has a remarkable record of fruitful collaboration with private enterprise. The only university in New York State to have two Centers of Excellence, in biotechnology and wireless technology, Stony Brook has promoted the launch of 44 companies through its high-technology incubators.

    Stony Brook University Medical Center is home to Suffolk County's only tertiary care hospital, with nearly half a million patient visits each year. Stony Brook University Health Sciences Center comprises the Schools of Dental Medicine, Health Technology and Management, Medicine, Nursing, and Social Welfare, and the Graduate Program in Public Health. The Long Island State Veterans Home is operated by Stony Brook University’s Health Sciences Center, and serves as a site for the education and training of long-term care and geriatric health care professionals.

    Stony Brook’s Staller Center is Suffolk County’s leading arts venue. A richStony Brook 1 program of theater, dance, classical music, and popular entertainment make Staller a vibrant attraction throughout the year. The Center hosts masterclasses and concerts by the world-renowned Emerson String Quartet, resident faculty at the University, and the spring Chamber Music Festival.

    Each summer, the Stony Brook Film Festival brings leading and emerging filmmakers and fans to the campus.
    One of America’s most diverse universities, Stony Brook celebrates the rich heritage of immigrant New York at the Charles B. Wang Center celebrating Asian and Asian American cultures. A second site, in the heart of Manhattan, connects the University to the world’s greatest city.

    Stony Brook is an engine of invention, creativity, and opportunity that has become a national model and a resource for the world.

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