PROVIDER ENROLLMENT COMPLIANCE

3 weeks ago

Baton Rouge LA USA, United States University of New Orleans Full time
Thank you for your interest in The University of New Orleans.

Once you start the application process, you will not be able to save your work, so you should collect all required information before you begin. The required information is listed below in the job posting.

You must complete all required portions of the application and attached the required documents in order to be considered for employment.

Department

Compliance Operations

Job Summary

Job Description

* Leads the oversight and audit the quality of work produced by the Provider Enrollment team ensuring established processes and procedures are followed.
* Leads the facilitation of quality assurance and continuous improvement efforts. Support continuous improvement projects within provider data and supporting departments.
* Create reports of departmental and vendor performance, systems performance, and recommended efficiencies to analyze and think critically about provider records management and process alignment while completing data quality reviews with attention to detail including accuracy, consistency and managing electronic files in a structured format.
* Serve as liaison between agency and Provider Enrollment vendor as well as LDH staff and the Fiscal Intermediary (FI) for design changes, LIFTS, issues with file and/or form discrepancies and special request as it arises.
* Prepare and deliver monthly operational review demonstrating accomplishments, progress, and challenges for assigned division / markets.
* Develop training material, Power Point presentations, and provide input regarding the creation of enrollment policies and procedures for the department.
* Monitor the activities of the Provider Enrollment (PE) Unit of the Fiscal Intermediary (FI) and be responsible for monitoring the enrollment and maintenance of over 100 provider types inclusive of over 50,000 providers.
* Monitor current and proposed state and federal regulations and clarifications for Impact on present program/system functions.
* Manage contractual obligations in accordance with state and federal compliance.
* Monitor activities of the Medicaid Provider Subsystem to ensure continued compliance with federal and state regulations, legislative or independent audit findings.
* Recommend criteria for implementing activities for the closure and removal (nonparticipating or no activity in eighteen months) of inactive files on the MMIS provider subsystem.
* Interface with agency bureaus/offices, contractors (such as Office of Mental Health, Health Standards, and Institutional Reimbursements) as well as state teaching facilities to implement eligibility of certain provider types whose enrollment requirements are more complex and require extended time.
* Meet and/or communicate with federal regulatory agencies, Fiscal Intermediary (FI) staff, providers, and program staff on program/system changes, enhancements and integrity.
* Attend meetings to coordinate implementation of policy changes, which affect providers.
* Participate in strategy development with the Fiscal Intermediary (FI) to formulate and implement such changes.
* Participate and execute development and implementation of the new Provider Management Project. Serve as the Provider Enrollment Subject Matter Expert.
* Lead and assist the Fiscal Intermediary, vendor and Provider Enrollment Compliance Coordinator 2 and 1's with the day-to-day operation of Provider Enrollment; serve as back-up performing day-to-day Coordinator 2 and 1 functions.
* Consult with and keep LDH management abreast of new developments, major changes and or issues.
* Consult with internal staff and external agencies regarding Provider Enrollment issues. Assist with procedures to get Provider Enrollment compliant with the Affordable Care Act (ACA) mandates.
* Coordinate, participate, review and approve the revisions made to the enrollment applications, forms, manuals and website.
* Research, develop and/or direct small Medicaid projects as assigned.
* Assist the Program Integrity staff regarding the enrollment files, for compliance purposes.
* Assist Program staff with the creation of new provider types and packets.
* Participate in provider workshops, seminars and or training, as requested.
* Monitor Provider Enrollment (PE) key performance metrics and stats produced by the vendor and Fiscal Intermediary.
* Assist internal departments, providers and potential providers to resolve Provider Enrollment issues and inquiries.
* Develop and document standard operating procedures (SOPs) and document current policies and procedures relative to the Provider Enrollment Compliance unit.
* Train new employees to the Provider Enrollment Compliance unit.
* Participate in all PEC unit modular system development projects within all areas of the SDLC (System Development Lifecycle) as assigned.
* Perform routine analysis on operational processes, creating data spreadsheets, pivot tables and charts.
* Other duties as assigned.

Required Qualifications:

* Bachelor's degree or six years of professional work experience in lieu of degree.
* Minimum two years of professional experience in healthcare compliance auditing, provider enrollment, or credentialing.
* Minimum two years of professional experience working with Medicare/Medicaid program support.
* Excellent analytical skills, effective organizational and time management skills.
* Great attention to detail and follow up, and verbal/written communications skills.

Desired Qualifications:

* Advanced degree
* Minimum three years of professional experience in healthcare compliance auditing, provider enrollment, or credentialing.
* Minimum three years of professional experience working with Medicare/Medicaid program support.
* Minimum three years of professional experience with claims processing and billing.
* Minimum two years of professional experience leading projects, along with testing and developing standard operating procedures.

Required Attachment(s)

Please upload the following documents in the Resume/Cover Letter section.

* Detailed resume listing relevant qualifications and experience;
* Cover Letter indicating why you are a good fit for the position and University of Louisiana Systems;
* Names and contact information of three references.

Applications that do not include the required uploaded documents may not be considered

Posting Close Date

This position will remain open until filled.

Note to Applicant:

Applicants should fully describe their qualifications and experience with specific reference to each of the minimum and preferred qualifications in their cover letter. The search committee will use this information during the initial review of application materials.

References will be contacted at the appropriate phase of the recruitment process.

This position may require a criminal background check to be conducted on the candidate(s) selected for hire.

As part of the hiring process, applicants for positions at the University of New Orleans may be required to demonstrate the ability to perform job-related tasks.

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