Sr. Managed Care Coordination Specialist
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Job Location:
Any - USA
Monthly Salary:
Not Disclosed
Posted on:
2 hours ago
Vacancies:
1 Vacancy
Job Summary
The Sr. Managed Care Coordination Specialist plays a vital role in the organizations Credentialing and Provider Enrollment Department. This position is responsible for the timely and accurate preparation and submission of provider rosters to contracted health plans (payers) to ensure that all providers are appropriately paneled and able to bill for services. The role will work closely with the credentialing team providers internal stakeholders care centers and external health plan contacts to maintain compliance with all managed care contracts and regulatory requirements.
- Lead the preparation and submission of comprehensive provider rosters to Managed Medicare Medicaid and commercial payers.
- Data Reconciliation: Audit internal provider data (NPI licenses specialties locations) against database records to ensure 100% accuracy before submission.
- Manage all payer portal uploads and secure email submissions maintaining a detailed log of submission dates and confirmation IDs.
- Serve as the primary point of contact for health plans to resolve roster discrepancies rejections or paneling delays.
- Maintain roster formats in accordance with individual payer requirements and regulatory standards.
- Utilize internal databases to provide weekly status reports and analyze provider enrollment timelines for process improvement.
- Partner with Revenue Cycle Management (RCM) to identify troubleshoot and resolve provider load issues causing claim denials or billing gaps.
- Other duties as assigned.
Qualifications :
- 5 years in healthcare credentialing provider enrollment or managed care analysis.
- Advanced Excel proficiency required. Candidates must be able to perform VLOOKUPs pivot tables and data cleaning for large datasets.
- Familiarity with credentialing databases for data management reporting and tracking. Experience in CredentialStream preferred.
- Deep understanding of CAQH NPI Availity and the provider enrollment lifecycle required
- Experience in Salesforce case management system preferred
- CPMSM CPCS or CPES certification through NAMSS preferred
The salary range for this role is $60000.00-$65000.00 in base pay and exclusive of any bonuses or benefits (medical dental vision life and pet insurance 401K paid time off and other wellness programs). This role is also eligible for an annual bonus targeted at 15%. The base pay offered will be determined based on relevant factors such as experience education and geographic location.
Additional Information :
All your information will be kept confidential according to EEO guidelines.
Technical Requirements (for remote workers only not applicable for onsite/in office work):
In order to successfully work remotely supporting our patients and providers we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age color national origin physical or mental (dis)ability race religion gender sex gender identity and/or expression marital status veteran status or any other characteristic protected by federal state or local law.
Remote Work :
Yes
Employment Type :
Full-time
Key Skills
- Shipping & Receiving
- Microsoft Office
- Customer Service
- Freight Experience
- Transportation Management Systems
- EDI
- Microsoft Outlook
- Supply Chain Experience
- Dispatching
- Microsoft Excel
- Logistics
- 3PL
About Company
Privia Health is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and popul ... View more
