• Enrolls new providers and groups with government and contracted payers
• Maintains database of provider IDs, NPPES logins, and CAQH logins
• Creates and maintains CAQH profile and ensures contracted payers receive updated information
• Revalidates providers and groups with government and contracted payers
• Pulls and creates ad-hoc reporting to identify credentialing issues impacting the billing team
• Work with the internal billing team, credentialing team, and vendors to share approvals and work through denials and appeal processes
• Maintains knowledge of current payer requirements
• Provide updates to CSM for communication of payer-related credentialing to clients, and attend client meetings/calls
• Manage AR questions as they pertain to provider enrollment denials/issues
• Maintains provider payer information in online credentialing databases and credentialing software
• Ensures practice addresses are current with health plans, agencies, and other entities
• Audits payer directories for current and accurate provider information
• Perform other reasonably related duties assigned by the immediate supervisor or other management personnel
• Contribute to team effort by accomplishing related results
• Promote a culture that reflects the organization’s values, encourages good performance, and enhances productivity

Skills: Enrollment, Credentialing, Database Management, Compliance, Reporting, Collaboration, Auditing, Communication

• Complete payer enrollment and re-credentialing applications for each insurance plan, obtain doctor’s signature, attach credentials, and submit and track applications.
• Participate in Payer Enrollment projects and initiatives.
• Respond on time to emails relating to Payer Enrollment.
• Manage and audit provider roster and participation reports for accuracy.
• Participate in weekly, monthly, and quarterly conference calls with assigned affiliates to keep an open channel of communication and compile a call summary to send to all participants.
• Follow up with affiliates and payers on outstanding issues in a timely and consistent manner.
• Provide an excellent customer service experience to affiliates.
• Preserve and update the database using an online software system to maintain the accuracy of the payer enrollment information submitted.
• Conduct training sessions (via Skype meeting) to support new doctor’s understanding of the enrollment process.
• Support and commit to a healthy relationship between the doctor group, affiliate, and Payer Enrollment team.

Skills: Payer Enrollment, Re-credentialing, Email Management, Roster Auditing, Communication, Issue Resolution, Database Maintenance, Training

• Serves as transfer policy expert by effectively serving incoming transfer students and faculty and communicating policies, processes, answering questions, and making referrals
• Assists in the recruitment of prospective transfer students
• Maintains telephone, email, and written communication with prospective transfer students
• Maintains transfer student database, and assists with student registration
• Maintains integrity of the Student Information System and other institutional student record systems as they relate to transfer students
• Analyzes statistics and distributes routine and ad hoc reports
• Evaluate and enter transfer students' coursework
• Corresponds with prospects, students, staff, faculty, and others to promote and facilitate the transfer process
• Maintains communication with post-secondary advisors from transfer institutions
• Develops and maintains relationships with transfer institutions
• Assists in the development of print and online transfer publications
• Responsible for maintenance of documentation for transfer procedures and processes
• Complies with institutional policies and procedures and makes recommendations for policy changes about transfer students

Skills: Transfer Policy Expertise, Student Recruitment, Communication Management, Database Maintenance, Data Analysis, Coursework Evaluation, Relationship Building, Process Documentation

• Coordinate workflows of all ‘paper’ new business, ad hoc client requests, and manual reconciliation of membership data
• Be a direct contact with clients to ensure accurate membership information and increased customer satisfaction.
• Execute new business and global transactions within turnaround times to avoid financial penalties
• Work closely with member enrollment analysts when these transactions impact electronic eligibility EDI clients.
• Ensure membership data queues, inquiry tracking, and other system processes are handled timely and accurate.
• Proactively communicate and coordinate membership data issues with Sales, Client Services, and Customer Service departments, and work collaboratively with these departments to develop solutions.
• Deliver membership data reports (e.g., eligibility listings) as required by the company and by the client.
• Oversee the ID card process, and act as a liaison between DentaQuest and the ID card vendor to ensure service level agreements are met.
• Identify cost-effective methods for issuing ID cards, and work directly with the ID card vendor to implement these solutions.
• Increase quality and productivity of manual, ‘paper’ enrollment by recommending policies, procedures, and workflows for improvements, ensuring quality metrics are met or exceeded.
• Work with management to streamline processes and reduce the cost of ‘paper’ enrollment and manual work.
• Work closely with Sales and Client Services to identify customer expectations and implement processes and procedures to ensure customer needs are met.
• Manage a high volume of projects and tasks with competing priorities.

Skills: Workflow Coordination, Client Communication, Transaction Execution, Data Accuracy, Issue Resolution, Reporting, Vendor Management, Process Improvement

• Assist people, including WFH patients, who need access to financial support for health care services, including the Health Insurance Marketplace
• Explain other health programs that increase health care access for which the patient or consumer may qualify and connect them with resources for program enrollment
• Develop a work plan for the assigned health center location and prepare a checklist that outlines in-reach activities
• Facilitate educational presentations for existing Westside Family Healthcare patients
• Provide information on the importance of primary and preventive care at community outreach events
• Attend all required administrative meetings and trainings for the program
• Complete timely reports detailing activities and the financial status of patients, including collections, following up on any discrepancies, and including data and narrative
• Develop extensive knowledge of health care and social service resources available in the community
• Daily communication (verbal and written) with dealership personnel
• Clear communication with internal clients on the progress of the install
• Create and maintain Salesforce.com and internal admin site records, including detailed notes regarding client contact and progress of tasks
• Collect, interpret, and enter information/documentation from the dealership

Skills: Financial Assistance, Program Enrollment, Work Planning, Educational Presentations, Community Outreach, Reporting, Resource Development, Communication Management

• Maintains effective processes for monitoring provider enrollment status for all payer funding sources
• Consistently recognizes and follows priorities for submission of complete enrollment processes to ensure accurate and timely collections
• Identifies and communicates all enrollment deficiencies to the Enrollment Manager on an immediate and ongoing basis
• Review applications and update submissions to confirm that all data is accurate and that all re-validation documents are completed and uploaded.
• Ensure all verification documents are complete and uploaded
• Contact providers and/or Clients either by phone and/or email to clarify or obtain missing documents from the provider application submission
• Demonstrates a commitment to eSolutions/ClaimRemedi guest relations by projecting a positive attitude while providing above-average resolution
• Coordinates and executes intake and enrollment activities and processes
• Develops relationships with prospective participants and families to facilitate the enrollment process
• Conducts intake meetings in facility and participants' homes in the Fresno area
• Implement an annual marketing plan to achieve enrollment goals

Skills: Provider Enrollment, Process Monitoring, Data Accuracy, Document Verification, Client Communication, Issue Resolution, Relationship Building, Marketing Planning

• Complete group/enrollment application submissions for new group contracts
• Follow-up on submitted group/enrollment applications to completion, escalating
• Secure and load all contracted fee schedules and any annual fee schedule changes
• Respond to internal requests for information, including contract status updates
• Maintain lists of provider relations contacts with various key payers
• Field email communications for in-process agreements
• Coordinate email, web, and social campaigns and their alignment across various programs
• Manage web content to maximize the enrollment funnel for lead acquisition, and application submission
• Project manage critical communications related to key admissions deadlines, admissions decisions, and next steps for matriculation
• Work collaboratively with various stakeholders to manage the marketing budget
• Work closely with the marketing automation and creative teams to create compelling email campaigns, engagement programs, and other various digital assets

Skills: Group Enrollment Management, Contract Follow-Up, Fee Schedule Management, Internal Communication, Provider Relations, Campaign Coordination, Web Content Management, Project Management

• Responsible for provider payer enrollment/credentialing and re-credentialing with all identified payers on time.
• Handles highly sensitive and confidential information regarding professional providers and guides the providers and practices on what is needed for a complete application to be presented to the health plans.
• Maintains all payor-related provider information in the Cactus system, including training, licensure, certifications, enrollment status, provider numbers, and billing addresses.
• Responsible for requesting and/or overseeing that the necessary additions, deletions, and changes of providers and provider information are entered into the Cactus system.
• Develops and sustains positive relationships with both internal and external customers (for example, insurance provider representatives) through ongoing communication and meeting participation.
• Reviews provider credentialing and/or re-credentialing data for accuracy based on licensing requirements and various insurer-payer requirements.
• Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified.
• Provides updates to on-site practice management staff and others with any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes as well as status on pending applications.
• Develops databases and spreadsheets for tracking organization providers.
• Ensures data is accessible/transparent for executive inquiries or other information deemed necessary.
• Facilitates delegated credentialing process in coordination with affiliated Professional Staff Affairs Office.

Skills: Provider Enrollment, Credentialing, Confidentiality, Cactus System, Relationship Building, Data Review, Issue Resolution, Data Tracking

• Prepare mailings for interested students.
• Process incoming and outgoing mail for the Office of Admissions.
• Prepare information packets for counselors, career fairs, and high school visits.
• Maintain active prospective student electronic files accurately.
• Complete student electronic and document files and update registration files.
• Maintains active prospective student files through precise evaluation of current admissions rules and procedures while monitoring program CAPs.
• Complete student electronic and document files and update files for registration.
• Serves as lead on CRM to maintain information related to admissions information and decisions for students, parents, counselors, other State Technical College offices, and walk-in visitors.
• Determines solutions for admissions scenarios by reviewing options and choosing the best to fit the situation.
• Processes applications into the database accurately and efficiently on time while determining which files to activate.

Skills: Mailing Preparation, Mail Processing, Information Packet Creation, Electronic File Management, Registration File Updates, Prospective Student File Evaluation, CRM Management, Admissions Scenario Resolution

• Assists with on-campus special events.
• Interprets admissions assessments to determine the status of students.
• Assesses files for appropriate status such as admitted, forward to admissions review, etc
• Evaluate the change of major forms to determine if the requested change can be made and process the request with considerations given to competitive and non-competitive programs and space available in the program.
• Responds on time through emails, phone calls, or in-person to prospective students.
• Determines whether an applicant meets admissions criteria for non-competitive programs and changes the status of the applicant to admit.
• Scheduling tours, testing, and apparatus testing.
• Coordinates tasks with work-study students.
• Email and mail merge letters from the database and produce reports – mainly using the Customer Relationship Management system – JRM
• Serves as backup to the Enrollment Specialist I position and Testing Coordinator with the processing of inquiry letters, downloading ACT scores, and verification of placements on the testing schedule each week.

Skills: Event Support, Assessment Review, File Evaluation, Major Change Processing, Student Communication, Criteria Evaluation, Scheduling, CRM Reporting

• Programming experience, preferably in college access and prep programs.
• Experience in veteran and/or college admissions recruitment
• Knowledge about the college preparatory process.
• Experience with externally funded, federal, or state academic support programs.
• Strong leadership, organization, interpersonal, written, and presentation communication, and information management skills
• Demonstrated commitment to serving and preparing underserved, racially and culturally diverse students for academic success and post-secondary enrollment
• Experience working with low-income, first-generation students.
• Experience with instructional design and virtual learning environments.
• Strong organizational, programming, motivational, and leadership skills.
• Strong interpersonal, written, presentation, and technology skills.
• Demonstrated commitment to diversity.

Qualifications: BA in Marketing with 3 years of Experience

• Experience working in healthcare or community support programs
• Case management working experience
• Teaching and/or public speaking experience
• Experience using Microsoft Office software suite (Word, Excel, PowerPoint)
• Working knowledge of Salesforce
• Reliable transportation and the ability to travel independently between work locations
• Willingness to work evenings and/or weekends
• Willingness to deliver presentations at public events
• Willingness to submit to a criminal background check following state and federal requirements
• Fluency in written and spoken English and Spanish

Qualifications: BA in Social Work with 1 year of Experience

• Experience working in the business environment with strong business acumen.
• Previous experience working with files or the collection and coordination of data
• Proficiency in the use of Excel.
• Experience working with general computer software (Word, Outlook.
• Ability to learn new software programs quickly.
• Good basic math skills.
• Excellent customer service skills, with verbal and written communication skills.
• Professional and effective interaction skills with co-workers, clients, and providers.
• Proven ability to work well individually and as a team member.
• Ability to prioritize and organize multiple tasks.
• Strong attention to detail.

Qualifications: BA in Communication Studies with 2 years of Experience

• Previous insurance verification experience
• Ability to problem solve in a proactive, creative manner while meeting deadlines
• Ability to work independently and as part of a team, and be flexible to changing needs
• Excellent communication skills, customer service oriented
• Computer proficiency using electronic medical records and SharePoint and must be able to type and navigate a Cloud-based environment and designated teleconferencing application
• Experience working in an outpatient clinic
• Familiarity with Medicaid/Medicare/Commercial Insurance practices
• Experience in a behavioral health setting
• Strong analytical and quantitative capabilities
• Ability to operate in an ambitious and continuously developing environment
• Maintain excellent punctuality and attendance during work hours

Qualifications: BA in English with 4 years of Experience

• Ability to interact with internal and external customers
• Flexible and adaptable to learning and understanding technology
• Highly analytical and detail-oriented with the ability to demonstrate command of details and to articulate those details at a higher level.
• Strong written, oral, and interpersonal communication skills
• Highly self-motivated, directed, and proactive
• Keen attention to detail
• Ability to effectively prioritize and execute tasks in a high-pressure environment
• Experience working both independently and, in a team-oriented, collaborative environment
• Able to communicate effectively within the department and with members of interdisciplinary teams
• Ability to work independently and proactively in a fast-paced, dynamic environment
• Proven analytical and problem-solving abilities

Qualifications: BA in Liberal Arts with 1 year of Experience

• Experience preferably in admissions, recruitment, enrollment, and/or partnership development
• Experience with social media campaigns to drive results
• Pipeline management experience (ability to convert prospective student to lead to information session attendee to interview scheduled to application completed to interview completed)
• Previous customer service experience (cold calling experience)
• Community outreach and public speaking experience
• Proven project management skills with strong attention to detail and follow-through
• Passion for and ability to use data to drive learning and improvement
• Ability to connect quickly and authentically with people
• Strong work ethic and positive attitude, with a willingness to be flexible
• Professional and resourceful style with the ability to work independently and as part of a team
• Experience working with external stakeholders, and experience with admissions
• Proficiency in Microsoft Office suite
• Knowledge of Salesforce.com

Qualifications: BA in Organizational Leadership with 3 years of Experience

• Related experience or relevant work experience.
• Computer skills and familiarity with the research process
• Hold BLS certification 
• Must have excellent organizational skills.
• Excellent interpersonal, verbal, and written communication skills.
• Must be self-directed and work with minimal supervision.
• Client-focused approach to work.
• A flexible attitude concerning work assignments and new learning.
• Ability to manage multiple and varied tasks with enthusiasm and prioritize workload with attention to detail.
• Willingness to work in a matrix environment and to value the importance of teamwork.

Qualifications: BA in Communication Studies with 2 years of Experience

• Experience in healthcare administration fields such as billing, credentialing, contracting, etc.
• Proficiency in Google Apps (Docs, Sheets, Gmail, Drive, etc) and Microsoft Office
• Proficiency with internet research and ability to quickly adapt to new software platforms
• Strong organizational and excellent follow-up skills
• Ability to interact effectively with a variety of people (physicians and medical staff offices)
• Provides the highest level of customer service for both internal and external customers
• Strong written and verbal communication skills.
• Excellent presentation and client interaction skills
• Must be highly self-motivated with a basic understanding of healthcare credentialing/contracting
• Highly motivated and success-driven with the ability to implement and manage cross-functional projects
• Ability to multitask and shift priorities when necessary

Qualifications: BA in Public Relations with 3 years of Experience

• Recruitment and outreach experience, or equivalent
• Demonstrated ability to work effectively both independently and as a part of a team.
• Strong cross-cultural, interpersonal, and writing skills, including public speaking skills and the ability to represent the University in a positive way to diverse populations.
• Ability to represent the admissions and recruitment profession positively through a strong, student-centered ethic.
• Work experience coordinating programs.
• Former student ambassador, tour guide, RA, orientation leader, or similar student involvement
• Must possess excellent computer skills and be proficient in MS Windows, Word, Excel, etc.
• Experience with database software tools such as PowerCampus, etc
• Demonstrated ability to interpret and apply CDU policies and procedures in furtherance of recruitment and admissions policies.
• Ability to gather data, compile information, and prepare reports.
• Ability to make administrative/procedural decisions and judgments.
• Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures.

Qualifications: BA in Economics with 5 years of Experience

• Experience in recruiting, public relations, sales, marketing, or related field
• Experience in any of the following capacities - professional higher education positions in student services-related functions, call center experience, high school college, and career advising, student worker/work study/ambassador on a college campus, customer service positions.
• Ability to compile and analyze information and data for reporting.
• Computer skills with knowledge of Windows, Excel, Word, PowerPoint, and Outlook. Experience with Operating Systems
• Must be able to establish and maintain effective working relationships with students, faculty, staff, and administrators.
• Strong cross-cultural, interpersonal, and writing skills.
• Patience, perseverance, and follow-through skills.
• Ability to prioritize and handle multiple demands successfully.
• Must be able to travel to different CSI locations throughout the day.
• Bilingual (Spanish/English)

Qualifications: BA in Sociology with 1 year of Experience