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Cedars-Sinai Manager, Enrollment & Eligibility - Managed Care (REMOTE) in El Encino, California

Remote: Highly qualified candidates, residing in California, Arizona, Nevada, Oregon, Texas, Colorado, Minnesota, Florida, and Georgia, will be considered for remote work. You must be a resident of one of these states to be considered for remote opportunities.

The Manager, MN Managed Care Enrollment and Benefits is responsible for processes associated with the internal maintenance of MDN provider data accuracy related to and communicated by Cedars-Sinai Medical Delivery Network on behalf of Cedars-Sinai Medical Care Foundation and affiliated medical groups.

Job Duties and Responsibilities:

  • Is responsible for the full scope of implementation of new or amended Medical Network (MDN) ancillary and provider contracts.

  • Understands the overall operations of the business to integrate provider information in its varied formations and functions.

  • Serves as a consultant to the Training Team’s management to develop or revise training curriculum related to MDN Provider Data management workflows.

  • Engages key collaborators within Cedars-Sinai Health System (CSHS) Managed Care & Payor Relations, Physician Billing (PBS) and MDN Network Management to develop standardized workflows for internal and external provider set-up.

  • Manages staff to ensure paneling information provided to Health Plans is accurate and timely to support Senate bill AB

    • Collaborates with Cedars-Sinai Medical Center (CSMC) and MDN operational departments to identify and resolve issues within CSHA/CSMG HMO referral data bases.
  • Develops audit mechanism(s) to identify system discrepancies which may impact referrals and claims.

  • Develops clear and concise educational materials regarding PIF and CRM completion.

  • Manages and approves Provider Information Forms (PIFs) related to the MDN’s managed care business.

  • Manages the validation of MDN-related fields within Epic’s Provider (SER) records.

  • Assumes responsibility for the accuracy of ancillary and provider contract data within EPIC’s Tapestry Module and associated HMO referral system(s) operations.

  • Is responsible for the accuracy of internal rosters to mitigate inadvertent leakage resulting from incorrect listings.

  • Reports high impact concerns/issues to leadership via the biweekly Managed Care Operations meeting.

  • Prepares policies and procedures as requested.

Education:

High school diploma/GED required. Bachelor's degree preferred.

Experience:

Five (5) years of experience in Managed Care required.

Working Title: Manager, Enrollment & Eligibility - Managed Care (REMOTE)

Department: MNS - Managed Care

Business Entity: Medical Network

Job Category: Strategic Plan/Business Dev

Job Specialty: Managed Care

Position Type: Full-time

Shift Length: 8 hour shift

Shift Type: Day

Cedars-Sinai is an EEO employer. Cedars-Sinai does not unlawfully discriminate on the basis of the race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer-related or genetic characteristics or any genetic information), marital status, sex, gender, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law.

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