ABOUT THE ROLE

At Hopscotch Primary Care, we take a team approach to serve patient needs and provide the best care possible. Our goal is to provide the care each of us would want for ourselves or for our family members, in the right setting, and at the right time. The Hopscotch Care Team is responsible for delivering high-touch, high-quality care to patients, including coordination of care across different physicians and the broader healthcare continuum.

As the Network & Value-Based Care Partnerships Senior Associate you will play a critical role in developing and maintaining provider credentialing, enrollment and roster management processes both internally and externally. The role is responsible for ensuring healthcare providers are credentialed and enrolled with various insurance plans, enabling seamless patient care and reimbursement processes. The role will support Value-Based Care Partnership but is not limited to workflow optimization, operational support, provider engagement, provider onboarding and driving excellence across all domains. The role will report to the Director of Network & Value-Based Care Partnerships.

• Responsible for preventing patient care disruptions with health plan partners regarding updates to provider rosters including provider enrollments, TIN changes, acquisitions, panel transfers or other material changes that will impact health plan provider directories.
• Initiates and oversees provider enrollment process with Hopscotch’s health plan partners.
• Identify workflow improvement opportunities to optimize value-based care performance and see through until completion.
• Communicates to internal stakeholders on expected timelines and potential delays in roster management.
• Maintains data accuracy with health plan partners through routine audits and accountable oversight.
• Review payer data and derive insights around key levers for contract performance, including but not limited to patient attribution and gap closure reports; bring solutions to internal teams and payers based on insights
• Ensure Hopscotch follows all regulatory requirements related to credentialing and health plan enrollment.
• Works closely with Finance, Network Strategy and Analytics to ensure alignment between health plan data and internal roster management.

What we are looking for

• Experience: Minimum of 4 years of experience in healthcare credentialing, enrollment and roster management.
• Strong knowledge of health plan and governmental credentialing standards, regulations and procedures.
• Strong organizational skills with the ability to manage multiple deadlines and priorities.
• Excellent communication and interpersonal skills. Ability to collaborate with healthcare providers
• Familiarity with Traditional Medicare and Medicare Advantage insurance plans preferred
• Expert knowledge navigating CMS applications, provider enrollments and ID updates, and provider licensing preferred

ABOUT YOU

You’ll be a great fit for this position if you have experience working in or with healthcare teams, especially in a primary care setting. You enjoy taking on diverse assignments and owning them to successful completion. Ideally, you have also had experience in one or more of the following areas: credentialing and enrollments, payor relations, and roster management. You also have a proven track record demonstrating:

• High EQ and a collaborative and trust-driven working style to quickly build relationships, internally and externally, to enable our work and culture.
• A high attention to detail and taking pride in ensuring tasks and processes are completed reliably with excellence
• Comfort with dynamic and sometimes ambiguous settings, showing the skill to bring a structured, proactive approach to prioritize and execute in a fast-paced, dynamic environment.
• Ability to learn quickly and leverage critical thinking and perseverance to take initiatives, solve problems, operate with autonomy and succeed in high-pressure situations.
• Willingness to roll up your sleeves, bringing a high work ethic and strong collaboration skills to work effectively with people of all backgrounds

From a cultural perspective, you:

• Act with Purpose – Bring intention with a focus on our mission and patients to everything.
• Strive for Excellence – Raise the bar and find ways to do better every day.
• Put the Team First – Bring your best and bring out the best in those around you.
• Be Skilled, Yet Humble – Lean into your skill and embrace new and different ways to get better.
• Give and Earn Trust – Act with integrity and honor your commitments.