WHO WE ARE

Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity.

WHAT YOU BRING & HOW YOU QUALIFY

• 3-5+ years of experience handling Payer enrollments, preferably for multi-disciplinary Provider groups.
• Extensive experience with Medicaid in a multi-state organization.
• Telehealth experience strongly preferred.
• Working knowledge of clinical operations and procedures.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to maintain confidentiality and discretion in all communications on behalf of Imagine Pediatrics Providers.
• Demonstrated advanced working knowledge of Verifiable, Athena, and Microsoft Office suite.
• Advanced skills in computerized spreadsheeting and database management.

WE VALUE DIVERSITY, EQUITY, INCLUSION AND BELONGING

We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We’re proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law

As a Credentialing & Enrollment Specialist – Payer Enrollment at Imagine Pediatrics, you will play a critical role, enabling our providers to make sure every child with complex medical conditions gets the care and support they deserve. You will:

• Manage payer enrollments for multi-disciplinary Providers with state Medicaid and payer partners, where applicable.
• Communicate clearly with providers, their liaisons, medical leadership and administration, as needed, to ensure application completeness and accuracy.
• Complete all applications electronically or via mail as prescribed by state Medicaid agencies and payer partners.
• Perform follow-up on enrollments via portal, phone, fax, or other prescribed process by state Medicaid agency and payer partners.
• Perform monthly roster reconciliation with payer partners to ensure accuracy of Provider records; ensure all adds, terms, and demographic updates are included in reconciliation process to avoid any impact to claims processing.
• Identify, analyze, and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact the ability to establish and maintain Provider enrollments.
• Discover and convey roadblocks to Enrollment to Senior Manager for sound decision making in accordance with Bylaws, credentialing policies and procedures, federal, state, local and government/insurance agency regulations.
• Maintain professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest developments to enhance understanding of various regulations and legislation of the health care industry.
• Perform miscellaneous job-related duties as assigned.