Company Overview
Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.
With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family’s ability to pay or insurance status. Please click here to learn more about our locations.
Job Description
As part of the SHC Department of Corporate Credentialing this position is responsible for deployment of governmental and commercial health plan requirements which Shriners Hospitals for Children sites participate with. The candidate will provide education and tools to the physicians, advanced practice professionals, and hospital and corporate staff; regarding payor specific guidelines for medical necessity, utilization management, prior authorization, quality metrics, and other requirements.
Continuously exemplifies the mission, vision, values and customer service philosophy of Shriners Hospitals for Children in job performance and in service to other persons outside of and throughout the organization.
Key Responsibilities:
Validates provider enrollments with health plans and coordinates with plans to ensure provider status is published and deployed to mitigate denials for professional fees.
Coordinate with Network Management to deploy health plans
Develops and implements education, and training materials to facilitate payor specific guidelines are diffused into practice.
Plans and manages projects, budget and resource allocation.
Facilitates regular reporting to internal departments, hospitals and headquarters leadership as needed.
Works closely with hospital and executive leadership, and appropriate hospital staff to expedite provider enrollment turnaround time.
Establishes and maintain close working relationships with hospital credentialing coordinators, network management, providers and other hospital/headquarter departments as appropriate and payer contacts.
Provides education with Care Management team to Optimize Health plan resource utilization.
This position is hybrid, with occasional onsite work (1–2 days weekly as needed) to fulfill payor requests for wet signatures.
Required Qualifications:
3 years of direct experience with managed care, third party and government insurance provider enrollment
Must have excellent computer skills (documentation, database management, spreadsheets), Adobe Pro, Microsoft Office Applications (Excel, Word, Outlook, PowerPoint, etc.)
Associates Degree in Business or related field
Preferred Qualifications:
NCQA auditing and/or accreditation experienced
Medicare/Multi-state Medicaid experience
Knowledge, development and implementation of enrollment workflow processes
Demonstrated experience with change management and ability to influence people not in a direct reporting relationship
The pay range for this position is $26.58 - $39.86. Compensation is determined based on years of relevant experience and departmental equity.
