Position Summary...
Our Health & Wellness Enrollment Services team is dedicated to ensuring Individual and Facility Providers are accurately and efficiently enrolled with multiple payers for pharmacy and optical claims reimbursement. We work cross-functionally to support access to care, strengthen provider experience, and advance the company's mission of helping people save money and live better by ensuring accessible and high-quality healthcare services. In this role, you will lead efforts to streamline enrollment processes, improve operational performance, and support a high-quality provider experience.
What you'll do...
What you'll do:
Lead payer provider enrollment operations across Health & Wellness business.
Lead and oversee facility and individual provider enrollment across Medicaid, MCO, Medicare, and commercial payers ensuring timely enrollment, compliance and alignment with state, federal, and internal requirements
Own a regional portfolio of states by ensuring timely, accurate enrollment submissions, monitoring due dates, portal issues, policy changes, and maintaining current SOPs. Lead appeals with Payers to reinstate and/or backdate enrollment when needed to prevent gaps in coverages, partnering across the team to resolve barriers while retaining accountability for final review and approval.
Participate in Payer contracts and Provider Manual reviews with internal stakeholders.
Develop and implement innovative strategies to streamline workflows, reduce processing times, and enhance overall provider experience, including the use of technology solutions to improve efficiency.
Analyze key performance indicators (KPIs) and enrollment data to identify trends, areas for improvement, and opportunities for process optimization.
Collaborate effectively with cross-functional teams (IT, legal, compliance, operations, contracting) to improve systems, procedures, and communication related to provider enrollment.
Mentor and develop a high-performing team of enrollment coordinators, fostering a culture of continuous improvement and excellence.
What you'll bring:
Commitment to maintaining the highest ethical standards and fostering a strong organizational structure that prioritizes efficiency, accuracy, and compliance.
Exceptional organizational skills and attention to detail, ensuring efficient and accurate enrollment processes.
Deep understanding of regulatory requirements and industry standards related to provider enrollment, including familiarity with various payer @types (governmental and commercial).
Strong analytical skills and the ability to translate data insights into actionable strategies for process improvement.
Proven leadership and team management skills, with a demonstrated ability to build and motivate high-performing teams.
Ability to travel domestically up to once per month.
At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more. You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable. For information about PTO, see https://one.walmart.com/notices . Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.
For information about benefits and eligibility, see One.Walmart (https://one.walmart.com/) .
The annual salary range for this position is $90,000.00 - $180,000.00 Additional compensation includes annual or quarterly performance bonuses. Additional compensation for certain positions may also include :
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Minimum Qualifications...
Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Option 1: Bachelor's degree in healthcare administration, business, accounting, economics, or related area and 3 years' experience in revenue cycle management, billing, payer enrollment, or related area.
Option 2: 5 years' experience in revenue cycle management, billing, payer enrollment, or related area.
Prior work experience in eligibility and insurance verification processes, provider enrollment, and EDI practices.
Prior work experience with enrolling providers and facilities in commercial and government plans across all 50 states.
Prior work experience in NCQA, Joint Commission, URAC, CMS, and state laws and regulations involving provider credentials.
Prior work experience in CAQH and credentialing processes.
Preferred Qualifications...
Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.
Master's degree in Healthcare Administration, Business, Accounting, Economics, or related area., NAMSS Credentialing/Enrollment Certification (CPCS, CPMSM).
Primary Location...
1601 SE 10th St, Bentonville, AR 72716, United States of America
Walmart and its subsidiaries are committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment.
Walmart, Inc. is an Equal Opportunity Employer- By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting, and valuing diversity- unique styles, experiences, identities, abilities, ideas and opinions- while being inclusive of all people.
