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Provider Enrollment Manager

Remote:

Full Remote

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

3-5 years experience in healthcare systems., Manager level experience required., Associate's degree or equivalent experience., Bachelor's degree preferred..

Key responsabilities:

Manage enrollment coordinators' workflows.
Oversee and update provider data.

Talent Group Scaleup http://www.talentgroups.com

501 - 1000 Employees

See all jobs

Job description

Duration: 6 months to start

Job Description

KEY REQUIREMENTS:

Manager level experience required.
Requires 3 - 5 years of experience in a healthcare system, group practice, Medical Staff Office, credentials verification organization or health plan.
Advanced Knowledge of provider enrollment required.
Experience with the MSOW portal required.

CERTIFICATES:

CPSC: Certified Provider Credentialing Specialist, strongly preferred.

EDUCATION:

Associates degree or equivalent experience. Bachelor s degree preferred.

KEY DUTIES:

CAQH - linking to our group EPM module and re-attesting providers (600+)
Updating MSOW/Verity with the offices/confirming sites of service
Medicare PECOS enrollment
Completing any forms potentially required
Keep a project tracker up-to-date

SYSTEMS AND REPORTING:

Accountable for overseeing and for directly updating provider data in the CAQH system, as necessary
Responsible for inputting provider enrollment information into Apogee and EPIC system and other Medical Center or Medical Group information systems
Distributes information to designated department representatives, billing vendors and credentialing administrators
Produces the weekly enrollment reports for team members and departments
Pulls rosters for insurance plans and BACO/ACO/insurance contracting needs

RESPONSIBILITIES:

Manages enrollment coordinators day-to-day work-flows, distributing workload in fair and equitable manner
Covers work gaps during staffing shortage to help meet department enrollment policy requirements
Implements the payer enrollment processes, providing guidance, support, and training to department members and identifies areas for process improvement
Reviews coordinators work to ensure completeness and quality, ascertaining opportunities for providing ongoing coaching and training as needed
Plans out workload for new provider enrollment and enrollment maintenance
Ensures Medicare and Medicaid Revalidations are submitted by staff
Assess billing inquiries pertaining to enrollment, managing workflow with team
Manages onboarding and training of new staff
In the Enrollment Manager s absence, the Team Lead assumes the responsibilities of the department manager.
Keep current regarding any changes in managed care and other third party payor requirements for provider enrollment.
Follow Medical Center & Medical Group policies and procedures as they relate to the provider enrollment process. Adhere to strict guidelines as established to assure payor and NCQA compliance.
Participate in audits conducted by the agencies and payors to measure the Medical Center/Medical Group compliance rate.
Acts as liaison to Faculty Practice Foundation and hospital departments, outside agencies, physicians, medical practice groups, 3rd party/governmental payers etc.
Enrollment Responsibilities

Responsible for ensuring timely enrollment of new providers with 3rd party payers; and the governmental payers including but not limited to Medicare and Medicaid. Performing follow up inquiries with payers as needed to complete provider enrollment.
Responsible for the on-going maintenance of existing active providers including but not limited to the submission of maintenance forms to update personal and practice demographic data, billing updates, et al.
Accountable for submitting termination requests to all health plans in a timely manner.

KNOWLEDGE AND SKILLS:

Work requires basic knowledge of credentialing and enrollment procedures / requirements.
Knowledge of basic office management procedures and extensive experience with enrollment procedures and requirements.
Ability to work well with all levels of personnel to establish and maintain harmonious working relationships with providers, chiefs of service, department directors and administrative staff and outside agencies.
Strong communication, time management and organizational skills required to keep a very large and complex system running efficiently.
Work requires ability to consolidate information from various sources.
Ability to identify problems in the credentialing and enrollment process and strong problem solving skills needed to resolve any problem as they arise.
Ability to prioritize duties, meet deadlines
Must have proven ability to maintain sensitive and confidential information.
Skilled in basic computer programs, such as Word and Excel. Experience with Microsoft Office.
Promotes and maintains a professional demeanor both personally and for Medical Center & Medical Group
Able to function independently and perform routine department procedures without supervision.