The Provider Enrollment Advisor will support the Provider Enrollment Manager and team for Nevada Medicaid. This person will guide the team to desired outcomes ensuring Gainwell is meeting Federal, State and Agency guidelines and achieving service level agreements while supporting team activities that are cost-effective and high-quality.
- A bachelor's degree and three years of experience in contact center operations, provider services or an agency program area or an equivalent combination of education and experience.
- Two years of experience working in a provider contact center, provider enrollment or other provider services teams in Medicaid or other major public or private health care programs.
- Five years experience in which problem solving and research were major keys to success.
- Working knowledge of HIPAA requirements.
- Demonstrable understanding of Medicaid provider functions.
- Knowledge of provider enrollment processes and requirements for CMS Federal and State Guidelines related to enrollment and reenrollment policies.
- Knowledge of Medicaid or Medicare guidelines.
- Six Sigma Lean Green or Black Belt certification, preferred.
- Ability to apply advanced problem-resolution skills to highly complex issues, quickly diagnose problems, and recommend appropriate and practical solutions on time.
- Effective documentation, written and verbal communications skills to convey complex information in a specific, clear, and concise manner.
- Strong organizational and project management skills and ability to prioritize tasks and see projects through from inception to completion on schedule.
- Self-starter and solutions oriented.
- Strong presentation skills to present to management and client.
- Advanced interpersonal communication skills to effectively support and collaborate productively with key stakeholders at all levels.
- Comfortable working with a remote team.
- 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.
- Plans, designs, and recommends business processes to improve and support team activities.
- Participates in meetings with clients to gather and document expectations and explore potential solutions.
- Analyzes client complex business requirements and processes; communicates these requirements to appropriate parties.
- Creates activities and timelines for projects and ensures deadlines are met.
- Assists with developing the methods and procedures required to identify whether current business goals and objectives meet organizational needs.
- Support Provider Enrollment Manager to monitor compliance with corrective action plans created through resolution.
- Act as a level of escalation for any real or suspected violation of Agency, State or Federal requirements.
- Building relationships with key stakeholders throughout the account to influence them to take action to drive progress.
- Being detail-oriented and capable of delivering a high level of accuracy.
- Open to Remote or Office environment