Enrollment Specialist, Medical Board

Are you looking to take your career to new heights with a leader in healthcare? SUNY Downstate Health Sciences University is one of the nation's leading metropolitan medical centers. As the only academic medical center in Brooklyn, we serve a large population that is among the most diverse in the world. We are also highly-ranked by Castle Connolly Medical, a healthcare rating company for consumers, among the top 5 leading U.S. medical schools for training doctors.

Bargaining Unit:

UUP

Job Summary:

The Department of Medical Board Credentialing at SUNY Downstate Health Sciences University is seeking a full-time Enrollment Specialist / TH Staff Assistant 2. The successful candidate will:

* Oversee the hospital's managed care enrollment and delegated credentialing for providers by maintaining compliance with National Committee for Quality Assurance (NCQA) standards, federal regulations, and hospital policies.

* Act as the authorized official for government plans (Medicare & Medicaid).

* Serve as the primary point-of-contact for day to day provider enrollment operations.

* Maintain National Provider Identifier & Council for Affordable Quality Healthcare database on behalf of assigned providers.

* Manage and update EMDNY and Pecos accounts.

* Update provider panels and reassigns files.

* Reconcile monthly health plan provider rosters for 25+ plans.

* Schedules, prepares and conducts pre-audits of credentials files for on-site and desk delegated credentialing audits.

* Manage the Managed care module In Cactus database to track provider demographics, CAQH IDs and payor participation status.

* Act as a liaison with Medical Group Leadership to ensure provider cooperation and understanding of financial ramifications related to delayed or incorrect enrollments.

* Respond to credentialing unbilled problems as indicated by the "holding report." Analyze and update billing reports submitted by the finance department. Reconciles billing denials with contracted billing vendors.

* Perform other job related duties and responsibilities as required and/or needed.

Required Qualifications:

* High School Diploma.

* 2+ years of Managed Care Enrollment work experience.

Preferred Qualifications:

* Knowledge of Symplr Cactus.

Work Schedule:

Monday to Friday; 8:30am to 4:30pm (Full-Time)

Salary Grade/Rank:

SL-1

Salary Range:

Commensurate with experience and qualifications

Executive Order:

Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor's Office of Employee Relations at  or via email .

Equal Employment Opportunity Statement:

SUNY Downstate Health Sciences University is an affirmative action, equal opportunity employer and does not discriminate on the basis of race, color, national origin, religion, creed, age, disability, sex, gender identity or expression, sexual orientation, familial status, pregnancy, predisposing genetic characteristics, military status, domestic violence victim status, criminal conviction, and all other protected classes under federal or state laws.

Women, minorities, veterans, individuals with disabilities and members of underrepresented groups are encouraged to apply.

If you are an individual with a disability and need a reasonable accommodation for any part of the application process, or in order to perform the essential functions of a position, please contact Human Resources at ada