Managed Care Delegation Specialist
Core
Ensures providers are credentialed and enrolled in insurance plans, manages delegated credentialing processes, and assists in contracting with managed care plans.
Role type
Provider enrollment and credentialing specialist
Builds
Provider rosters and contract compliance for system hospitals
Domain
Healthcare administration / Managed care
Required skills
Credentialing database management, Microsoft Excel (advanced), Provider relations, Contract review and negotiation, Data query tools, Regulatory compliance (NCQA)
Preferred skills
Experience with credentialing databases, Provider enrollment experience
Responsibilities
Ensures providers are credentialed and enrolled in insurance plans, Acts as a liaison between medical staff offices and delegation payors, Manages delegated credentialing processes and assists in contracting with managed care plans, Ensures monthly and quarterly notifications for provider updates are distributed, Utilizes databases and query tools to gather data for reporting specifications, Resolves reimbursement discrepancies with payors for credentialing issues