Enrollment Specialist, Medical Board

Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.

Bargaining Unit

UUP

Job Summary

• The Department of Medical Board Credentialing at SUNY Downstate Health Sciences University is seeking a full-time Enrollment Specialist / TH Staff Assistant 2. The successful candidate will:
• Oversee the hospital's managed care enrollment and delegated credentialing for providers by maintaining compliance with National Committee for Quality Assurance (NCQA) standards, federal regulations, and hospital policies.
• Act as the authorized official for government plans (Medicare & Medicaid).
• Serve as the primary point-of-contact for day to day provider enrollment operations.
• Maintain National Provider Identifier & Council for Affordable Quality Healthcare database on behalf of assigned providers.
• Manage and update EMDNY and Pecos accounts.
• Update provider panels and reassigns files.
• Reconcile monthly health plan provider rosters for 25+ plans.
• Schedules, prepares and conducts pre-audits of credentials files for on-site and desk delegated credentialing audits.
• Manage the Managed care module In Cactus database to track provider demographics, CAQH IDs and payor participation status.
• Act as a liaison with Medical Group Leadership to ensure provider cooperation and understanding of financial ramifications related to delayed or incorrect enrollments.
• Respond to credentialing unbilled problems as indicated by the "holding report." Analyze and update billing reports submitted by the finance department. Reconciles billing denials with contracted billing vendors.
• Perform other job related duties and responsibilities as required and/or needed.

Required Qualifications

• High School Diploma.