McLaren Health Care Provider Enrollment Specialist in Auburn Hills, Michigan

18-2514

Post Date

5/17/2018

Title

Provider Enrollment Specialist

Job Family

Administrative/Clerical

Subsidiary

McLaren Health Care

Department

90560 - Managed Care

City

Auburn Hills

State

MI

Full Time

Yes

Hours per 2 week pay period

80

Weekends and/or Holidays Required

No

On Call Required

No

Description

McLaren Health Care is one of Michigan's fastest growing health systems. With 12 hospitals, annual revenues of over $3 billion, and a service area that covers 75% of the state, McLaren is committed to the highest levels of patient care.

McLaren Physician Partners, McLaren Health Care, is seeking an experienced Enrollment Specialist to join the team and support the organization.

JOB SUMMARY:

Responsible for assisting in the development and implementation of the MPP Membership and credentialing processes for NCQA recertification, and Health Plan enrollment processes for MPP approved members and health care professionals. Works directly with

Enrollment team, Vice President of Operations, Contract Administrator and Medical Leadership to refine data base information for reporting and accurate enrollment numbers, as well as ACO (Accountable Care Organization) and CIN (Clinically Integrated Network)

memberships.

REQUIRED QUALIFICATIONS:

  • Associates Degree; an equivalent combination of relevant education and experience may be substituted for the educational requirement.

  • Three to five years of health plan enrollment, credentialing, coding and/or billing of primary care physicians.

  • Experience with NCQA certification/recertification

  • Working knowledge with delegated credentialing contracts, including plan audits

  • Ability to create, edit and modify provider rosters via Excel.

PREFERRED QUALIFICATIONS:

  • Bachelors in Business or Healthcare preferred

NOTE: To further our mission of enhancing the health status of the individuals and communities we serve, effective February 1, 2013,McLaren Health Plan will no longer hire individuals who use tobacco or nicotine products in any form. Cotinine

testing will be used to verify non-tobacco use. Individuals whose health screening results are verified positive for tobacco/nicotine use will be disqualified from employment, their job offer will be rescinded, and they will be disqualified from reapplying

for employment for six (6) months from the date of the health screening.

  • Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

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