Sr. Enrollment and Analytics Specialist (remote)

Job Description

Pay Range: $74,000 - $134,000 / year

Salary offers are based on a wide range of factors including relevant skills, training, experience, education, and, where applicable, certifications obtained. Market and organizational factors are also considered. Successful candidates may be eligible to receive annual performance bonus compensation.

Benefits Information:

We are proud to offer best-in-class benefits and programs to support employees and their families in living healthy, happy lives. Our pay and benefit plans have been designed to promote employee health in all respects - physical, financial, and developmental. Depending on whether it is a part-time or full-time position, some of the benefits offered may include:
• Day 1 Medical, supplemental health, dental & vision for FT employees who work 30+ hours
• Best-in-class well-being programs
• Annual, no-cost health assessment program Blueprint for Wellness®
• healthyMINDS mental health program
• Vacation and Health/Flex Time
• 6 Holidays plus 1 "MyDay" off
• FinFit financial coaching and services
• 401(k) pre-tax and/or Roth IRA with company match up to 5% after 12 months of service
• Employee stock purchase plan
• Life and disability insurance, plus buy-up option
• Flexible Spending Accounts
• Annual incentive plans
• Matching gifts program
• Education assistance through MyQuest for Education
• Career advancement opportunities
• and so much more!

Manage analytics and deliverables with Health Plan and Government payers as required by the Commercial payers, Centers of Medicare & Medicaid Services (CMS), Department of Health (DOH) for Quest Diagnostics, its subsidiaries, affiliates, and their respective testing facilities. Drive process compliance, controls and standardization utilizing a Centers of Excellence methodology to support all reporting analytics and Provider Enrollment activities.

Responsibilities

• Engage with federal & state government and third-party payers on current and future regulatory requirements
• Create and manage central repository of key reference information regarding provider application requirements
• Develop and manage reporting for provider enrollment activities
• Engage with Compliance, Legal, Laboratory Operations, Optum, Risk Management, Health Plans, and Business Development on strategic initiatives, federal and state requirements for enrollment, and other payer requests
• Create and update SOPs and playbooks to ensure that processes are aligned with the Centers of Excellence key business objectives, government, and industry standards
• Complete requests for federal & state government and third-party payers to include completion of, but not limited to, provider enrollment applications, revalidation requests, NPI enrollments, third-party payer credentialing and attestations
• Train team members on changes in enrollment requirements
• Perform Quality Assurance/Quality Control (QA/QC) on team enrollment and credentialing submissions
• Perform thorough credit evaluations to assess financial risk of customers, ensuring compliance with company's credit policies and guidelines
• Distribute monthly rosters of patient-facing facilities to ensure accuracy in various third-party payer directories
• Govern and distribute a catalogue of all testing facilities for the purpose of internal analytics that is used for contract negotiations and engagement with third-party payers
• Manage the updates of the online registry for commercial payers including their contractual status with Quest Diagnostics, its subsidiaries, and affiliates

Qualifications

Education:

• Bachelor's degree in business administration (preferred), Certification or equivalent

Required Work Experience:

• 5+ years' relevant experience, including working knowledge of Medicare and Medicaid provider network requirements, enrollment, or third-party payer credentialing
• 5+ years' experience in Lab Industry and/or Healthcare industry and a comprehensive understanding of highly matrixed organizational structures

Preferred Work Experience:

• Work experience in Provider Enrollment and Credentialing including understanding of state regulatory requirements for Enrollment submission

Knowledge:

• Medicare Provider Enrollment, Chain, Ownership System (PECOS)
• State Medicaid Web Portals
• Council for Affordable Quality Healthcare (CAQH) Provider Daily Portal
• National Plan and Provider Enumeration System (NPPES)
• Salesforce.com or comparable CRM Tool
• Credentialing Software

Skills:

• Strong analytical and critical thinking skills
• Strong written and verbal communication
• Process planning and organization
• Strong technical skills in MS Word and Excel
• Able to multi-task and perform in a fast-paced environment

About the Team

Quest Diagnostics honors our service members and encourages veterans to apply.

While we appreciate and value our staffing partners, we do not accept unsolicited resumes from agencies. Quest will not be responsible for paying agency fees for any individual as to whom an agency has sent an unsolicited resume.

Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets or any other legally protected status.

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