Responsibilities

Lead all payer credentialing, re-credentialing, enrollment, and network participation activities across commercial payers, Medicare contractors, all state Medicaid programs and their associated managed care plans, laboratory benefit managers, and other reimbursement stakeholders. Own the end-to-end lifecycle, including initial applications, revalidation, roster and demographic updates, and ongoing maintenance requirements.
Manage state-specific Medicaid enrollment requirements, including out-of-state laboratory enrollment where permitted, documentation and attestations, application fees, risk-level screening obligations such as fingerprinting and site visits, and subsequent contracting with Medicaid managed care plans once state enrollment is active.
Manage federal government documentation, including SAM ID and associated opportunities, Federal Supply Schedule changes, FSS applications, and documents related to SBA plans, within required federal timelines.
Coordinate ownership, control, and managing employee disclosures required by payer and government enrollment applications, working with Legal, Human Resources, Compliance, and executive leadership to gather and safeguard sensitive information.
Maintain accurate laboratory, facility, and organizational records across payer systems and enrollment platforms, including NPPES and PECOS demographic data, NPI and taxonomy assignments, PTAN alignment, W-9 and remittance addresses, and payer directory listings.
Partner with Regulatory and Quality to ensure CLIA certification and state clinical laboratory licenses and permits remain current, and align enrollment activities with state licensure prerequisites.
Own the contract lifecycle after execution, including effective and termination dates, renewal and notice windows, amendments, and escalation of approaching deadlines to the contracting leads.
Establish and maintain the system of record for market access documentation, including executed agreements and amendments, payer medical policies and coverage determinations, payer correspondence, and supporting evidence and dossier materials. Maintain version control, access permissions, and retention standards across document management, Customer Relationship Management (CRM), and Contract Lifecycle Management (CLM) platforms.
Collaborate with Reimbursement Operations (RCM) teams to identify and resolve enrollment-related claim issues, reimbursement delays, and payer operational challenges, including those involving payer portals such as Availity.
Develop and maintain standard operating procedures, process documentation, and operational controls related to enrollment, payer setup, contract administration, and reimbursement operations. Support related payer audits, credentialing reviews, and compliance requests.
Select, implement, and administer enrollment tracking and contract repository systems, and manage credentialing vendors, external consultants, and third-party partners.
Develop dashboards, reporting, and key performance indicators that measure operational performance, including enrollment cycle time by payer type, percentage of target Medicaid lives with active enrollment, on-time revalidation rate, denial dollars attributable to enrollment or configuration defects, and contract record completeness.

Sr. Genomic Specialist, Cincinnati at Veracyte · LumiJobs

Sr. Genomic Specialist, Cincinnati

Responsibilities

Qualification

Required

Benefits

Company

Veracyte

More roles at Veracyte