Provider Enrollment Manager managing Medicaid provider enrollment and compliance at HMS, a Gainwell Company. Ensuring operational efficiency and high-quality service delivery within healthcare enrollments.
Responsibilities
Manage the end-to-end Medicaid provider enrollment process, ensuring compliance with CMS and state requirements
Day-to-day operations of the provider enrollment lifecycle including new enrollments, revalidations, and maintenance updates
Supervise staff performance to meet or exceed Service Level Agreements, turnaround times, and quality targets
Ensure compliance with state and federal regulations, manage team performance, and partner closely with clients and internal stakeholders to deliver accurate, timely, and high-quality enrollment processing
Utilize the Medicaid Management Information System (MMIS) as the system of record for updating provider data, uploading approved enrollment documents, and maintaining data accuracy
Oversee workflow and document processing using OnBase (Hyland) for document imaging, indexing, and secure storage
Use Verint Workforce Management (WFM) tools to monitor productivity, adherence, and staffing needs
Develop and maintain Standard Operating Procedures, training materials, and quality control procedures
Analyze trends and data to guide strategic planning and continuous improvement initiatives.
Requirements
Bachelor’s degree in healthcare administration, business administration, public health, or a related field
Minimum of five (5) years of experience in Medicaid provider enrollment, credentialing, or similar healthcare operations functions
At least three (3) years supervisory or management experience, leading teams in an operational or production-driven highly matrixed environment
Working knowledge of Medicaid Management Information Systems (MMIS) and Medicaid provider data standards
Exceptional written and oral communication and people skills.
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