NYC Health + Hospitals

About NYC Health + Hospitals

Empower Every New Yorker — Without Exception — to Live the Healthiest Life Possible

NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city’s five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services.

Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Job Description

Working under the direct supervision of the Senior Director of Managed Care, Central Office, the Senior Management Consultant Level 1/Senior Provider Enrollment Specialist will be responsible for initiating and maintaining active participating enrollment status of providers with government payors and managed care plans. The candidate must be highly motivated, able to take initiative and manage provider enrollment activities for delegated credentialing arrangements and individual provider enrollment via CAQH.

Key responsibilities include:

• Collect and maintain a complete record for individual providers in system’s database MD-Staff.
• Prepare and/or send Medicaid and Medicare initial and revalidation forms to individual providers to ensure timely submission of enrollment forms to government payors.
• Collaborate with facility and affiliate teams on follow-up efforts to ensure provider successfully returns completed and signed enrollment forms.
• Compile and submit provider data on delegated rosters to contracted managed care plans at least once a month.
• Record and maintain inventory of milestone dates of provider rosters submitted to government payors and managed care plans in MD-Staff to capture provider’s enrollment status.
• Monitor delegated provider rosters submitted to managed care plans and notify plans of any past-due rosters that require processing.
• Meet regularly with local hospital administrators to identify billable providers who are not part of the medical staff (aka non-credentialed providers) requiring direct credentialing by managed care plans in order to submit claims.
• Send and process MD-Apps to non-credentialed providers to collect CAQH number and submit applicable forms to plan for direct credentialing.
• Participate in monthly system-wide provider enrollment meetings to develop and implement best practices.
• Troubleshoot and identify root cause of provider data problems with payors and take active role to resolve issue(s).
• Serve as key liaison to Central Office, Centralized Credentialing team, Local Medical Staff Office(s), Managed Care plans and other key stakeholders to assist with provider data requests.
• Other duties as may be required.

Minimum Qualifications

1.Master’s degree from an accredited college or university in Public Health, Public Administration, Business Administration, Social Work, Psychology or Rehabilitation Counseling; and one (1) year of full-time experience in medically-oriented health care and medical support systems environment; or

2.Bachelor’s degree from an accredited college or university in disciplines listed in “1” above; and two(2)years of full-time experience in medically-oriented health care and medical support systems environment; or

3.A satisfactory equivalent combination of education, training and/or experience, in which each year of relevant training and/or experience can be substituted for 30 semester credits from an accredited college or university. However, all applicants must at least have a Bachelor’s degree or its educational equivalent.

Department Preferences

• Expert in provider enrollment with government payors and managed care credentialing/enrollment.
• Expert in CAQH
• Effective communication skills both verbally and written
• Proficient in excel to utilize v-lookup, pivot tables, concatenation, and other reporting tools to validate data from multiple sources
• Advanced analytical and problem-solving skills with attention to detail and accuracy
• Microsoft Office: Excel, Access, Outlook, Word
• MD-Staff

How To Apply

If you wish to apply for this position, please apply online by clicking the "Apply Now" button.

If applying online, please include your cover letter in the same file attachment with your uploaded resume.

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs