Somnia, a national anesthesia practice management company, which was recently named one of the 50 fastest growing privately held New York-based companies by Crain’s New York Business and one of “Healthcare’s Hottest” by Modern Healthcare magazine, is seeking an experienced credentialing leader. In this position candidates will oversee the day to day operations of the managed care team which will involve working with clients and major insurance companies throughout the country. Strong CACTUS skills required.
• Be responsible for the maintenance, enhancement and oversight of managed care and government payer applications.
• Identify, create and maintain payment enrollment process for new or existing clients for both managed care organizations (MCOs) and government payers.
• Manage payment enrollment process for clinicians practicing in inpatient and outpatient settings. Ensures applications are submitted with all supporting documentation as required by the client or MCO to allow for timely credentialing.
• Prepare and produce correspondence to clients, clinicians, MCOs and government payers.
• Enroll clinical personnel into MCOs Medicare and Medicaid (DCC).
• Develop and maintain effective enrollment contacts with clients and MCOs nationally.
• Work with offshore team to facilitate enrollment process.
• Maintain and prepare enrollment packets by state and ensure all applications are the latest version.
• Perform regular and routine follow-up with clients and payers on the status of clinician enrollment applications.
• Produce weekly follow up reports on all credentialing activities.
• Assist with Claims resolution as necessary.
• Identify and update internal departments of changes in client, MCO and government policy and procedures and enrollment related processes.
• Perform database audits.
• Perform special projects and related duties, as required.
DESIRED SKILLS & EXPERIENCE
• Bachelor’s degree preferred or equivalent experience
• Minimum 2 years management experience/oversight experience
• Minimum 2 years provider enrollment experience with large group practice, hospital or management company preferred
• Knowledge of the commercial health insurance industry, industry practices and government payers.
• CACTUS database experience minimum 1 yr required
• Enrollment, Credentialing & Managed Care experience preferred
• Ability to work independently, multi-task and handle a heavy work load in a fast-paced environment
• Strong decision-making and problem solving skills
• Strong written and verbal communication skills
• Strong computer skills
• Excellent organizational skills a must
Phone: 877-476-6642, ext. 3548
Please fax your CV to 877-580-2191
Providing anesthesia services to healthcare facilities, Somnia, Inc. is a national provider of turn-key Anesthesia Service Management. By...