Senior Managed Care Specialist-(PROVIDER ENROLLMENT)
St. Jude Children's Research Hospital
Summary
The Senior Managed Care Specialist - PROVIDER ENROLLMENT is responsible for managing provider enrollment duties and tasks, implementing and maintaining all data and activities related to the enrollment of hospital employed or contracted physicians into all contracted insurance programs, including State Medicaid programs. Their primary goal is to ensure efficient and cost-effective healthcare delivery while maintaining high-quality standards.
Job description
Job Responsibilities
- Independently execute and manage managed care tasks within own area of responsibility (e.g., provider enrollment and credentialing, claims, payor issues).
- Work closely with internal and external teams (e.g., clients, customers) to coordinate, clarify information, and resolve issues.
- Support payer communications efforts (e.g., new publications, guidelines) and other supportive documentation.
- Manage denial issues related to contractual, enrollment or credentialing issues in a timely manner; monitor own delivery for compliance with overall guidelines, policies & procedures.
- Perform other duties as assigned to meet the goals and objectives of the department and institution.
- Maintains regular and predictable attendance.
Minimum Education and/or Training
- High school diploma/GED required.
Minimum Experience
- Minimum Requirement: 4+ years of experience in a healthcare, academic or research setting.
- Experience in healthcare office environment with some understanding of managed care contract and reimbursement models.
- Manage denial issues related to contractual, enrollment or credentialing issues in a timely manner; monitor own delivery for compliance with overall guidelines, policies & procedures.
- Proven performance in earlier role.
- Experience with EPIC and CREDENTIALSTREAM preferred.
- Prior PROVIDER ENROLLMENT experience is strongly preferred.
Requirements
- High school diploma/GED required.
- Minimum 4+ years of experience in a healthcare, academic or research setting.
- Experience in healthcare office environment with some understanding of managed care contract and reimbursement models.
- Experience with EPIC and CREDENTIALSTREAM preferred.
- Prior PROVIDER ENROLLMENT experience is strongly preferred.
Company overview
St. Jude Children's Research Hospital is a world-renowned pediatric research and treatment institution headquartered in Memphis, Tennessee, dedicated to advancing cures for childhood cancer and other catastrophic diseases. Founded in 1962 by entertainer Danny Thomas, it stands as the first and only National Cancer Institute-designated Comprehensive Cancer Center devoted exclusively to children. The hospital operates on a unique funding model where families never receive bills for treatment, travel, housing, or food, with costs exceeding $2 billion annually primarily supported by donations through its fundraising organization ALSAC. St. Jude treats approximately 8,600 patients each year from all 50 states and around the world, with a focus on acute lymphoblastic leukemia, brain tumors, sickle cell disease, and infectious diseases. The institution employs over 7,000 staff members and maintains eight affiliate clinics across the United States. Through its St. Jude Global initiative, the hospital shares research and treatment protocols internationally, partnering with more than 350 institutions in over 90 countries. St. Jude has been instrumental in increasing childhood cancer survival rates from 20% in 1962 to over 80% today, while maintaining a robust research program that includes gene therapy, bone marrow transplantation, and precision medicine approaches.