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Provider Enrollment Advisor

Date:  Nov 25, 2022

Any city, NV, US, 99999

Req ID:  12034


Job Description

Job Description
The Provider Enrollment Advisor will support the Provider Enrollment Manager and team for Nevada Medicaid. This person will act as a subject matter expert for business applications and team processes. This role requires analysis of data to make recommendations that are cost effective and high-quality. This person supports the business meeting Federal, State and Agency guidelines and service level agreements with the client. 


•    Bachelor's degree in a related field and/or equivalent combination of education, training, and experience.
•    Five years of experience in healthcare operations (managed care, providers, members, etc.).
•    Three years of experience in credentialing/provider enrollment. 
•    Knowledge of provider enrollment processes and requirements for CMS Federal and State Guidelines related to enrollment and reenrollment policies, preferred.
•    Experience with MMIS (Medicaid Management Information Systems), preferred. 
•    Ability to apply advanced problem-resolution skills to highly complex issues, quickly diagnose problems, and develop, test, and recommend appropriate and practical solutions on time.
•    Advanced written and verbal communications skills to convey complex information in a specific, clear, and concise manner.
•    Advanced organizational and project management skills and ability to prioritize tasks and see projects through from inception to completion on schedule.
•    Strong presentation skills to present to management and customers.
•    Ability to handle multiple tasks simultaneously and switch between tasks quickly while still meeting deadlines. 
Primary duties include but are not limited to:
•    Serves as subject matter expert for Federal, State and Agency requirements impacting provider enrollment, and as a compliance resource for the business.
•    Analyzes client complex business requirements and processes; communicates these requirements to appropriate parties.
•    Provides input into developing and modifying systems to meet client needs and develops business specifications to support these modifications.
•    Assists with developing the methods and procedures required to identify whether current business goals and objectives meet organizational needs.
•    Aggregate, analyze and report on data, including but not limited to identifying trends around errors, RTP (return to provider) reason codes, and efficiency opportunities, discovering their root causes, and making recommendations for performance improvement. 

Work Environment
•    Position can be remote or in Reno, NV. 

Job Description


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