It's more than a career, it's a calling. MO-REMOTE Worker Type: Regular Job Highlights: Join a team that plays a key role in ensuring provider data accuracy, regulatory compliance, and strong partnerships across the healthcare ecosystem. As a Managed Care Delegation Specialist, you'll work closely with providers, health plans, and internal teams to support delegated functions, maintain data integrity, prepare for audits, and drive operational excellence.
This is an ideal opportunity for someone who enjoys problem-solving, working with complex data, building provider relationships, and supporting operational excellence across the healthcare continuum. Candidates should reside in MO, OK, WI or Southern IL. Hybrid role with initial onsite training and occasional in-person meetings required.
Schedule - M-F with start and stop times between 6am and 6pm. Candidate schedule during this timeframe must be consistent. The selected candidate will support all Regions.
Job
Responsible for provider enrollment with commercial payors, managed care contracts, and delegation audit activities for the system hospitals or organization. Works independently with complex data and situations.
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PRIMARY RESPONSIBILITIES Ensures providers are credentialed and enrolled in insurance plans. Acts as a liaison between medical staff offices, credentialing verification offices, and delegation payors. Remains knowledgeable of medical staff bylaws, rules and regulations, and policies for the system hospitals or organization.
Stays up to date with National Committee for Quality Assurance (NCQA) standards and reports back to stakeholders with new information pertinent to credentialing. Manages delegated credentialing processes and assists in contracting with managed care plans. Reviews and interprets new and existing contracts to ensure they meet Managed Care Organization (MCO) specifications.
Negotiates recommended changes to contracts to ensure compliance. Ensures monthly and quarterly notifications for provider updates are distributed. Provided notifications of on-going rosters, new providers, resignations and/or change of status requests, location changes, and/or changes in provider privileges.
Utilizes a variety of databases and query tools to gather data. Ensures all requirements are well-defined from the MCO to meet reporting and analysis specifications. Works closely with team members to establish reporting and dashboards within applications that will support operations.
Resolves reimbursement discrepancies with payors for credentialing issues. Performs other duties as assigned. EDUCATION High School diploma/GED or 10 years of work experience EXPERIENCE At least 3 years of experience working with providers, provider offices, or provider networks in a healthcare setting.
Experience supporting credentialing, managed care operations, provider relations, provider enrollment, medical staff services, or healthcare compliance activities. Familiarity with delegated functions such as credentialing, utilization management, prior authorization, claims, or provider data management. Experience using credentialing or provider management systems.
Strong Microsoft Excel skills, including experience tracking metrics, validating data, generating reports, and identifying discrepancies. Experience maintaining, auditing, or analyzing large volumes of provider, credentialing, or operational data. Knowledge of healthcare regulatory, compliance, audit, payer, or accreditation requirements.
Demonstrated attention to detail with the ability to ensure accuracy, completeness, and compliance of records and documentation. Experience preparing documentation for audits, monitoring corrective actions, or supporting compliance reviews. Strong communication and collaboration skills with the ability to work effectively across departments and with external stakeholders.
REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS None Department: 8764090033 Provider Enrollment Work
Day Shift Scheduled Weekly Hours: 40 SSM Health is an Equal Opportunity Employer. SSM Health provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender, pregnancy, sexual orientation, gender identity, national origin, age, disability, protected veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law.
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