Team Lead Provider Enrollment

3 weeks ago

Janesville, United States CareerBuilder Full time

JOB REQUIREMENTS:
Overview Enrollment Team Lead, Medical Staff, Days, 80Hrs / 2 wks Location: Mercyhealth Trauma Center; Janesville, WI or Rockton Ave Campus; Rockford, IL. Hybrid work schedule opportunity available after training period.

The Enrollment Team Lead works as a liaison between Medical Staff Office management and partners, communicating policies, procedures and workflows, as well as providing training and monitoring work volumes. Performs other duties as assigned.

Responsibilities:

The Team Lead will provide consistent, accurate and timely enrollment support, enhancing Mercy System's ability to provide professional services, including timely and accurate verification, validation and documentation of the information provided by all applicants.

Ensures provider files are kept confidential at all times.

Coordinates operations with other departments to ensure smooth workflow.

Assists with short-term and long-term goal setting.

Understands and maintains an in-depth knowledge regarding the requirements for credentialing physicians and other allied health provider types with Wisconsin and Illinois Medicaid, Medicare, Medicaid, and third-party payers as necessary. Participates in provider enrollment application preparation, finalization, submissions, follow up and resolution.

Assists with accurate and complete data entry of credentialing and enrollment information into the credentialing database. Develop into database super user and work with database support staff to ensure updates are implemented.

Responds to inquiries regarding enrollment status, handles provider correspondence as necessary to process enrollments, and maintains knowledge of and compliance with TJC, NCQA, CAQH, and CMS standards, as appropriate.

Assists with the coordinator hiring process and training of new employees. Provides mentoring to staff members and assists with performance appraisals, disciplinary actions, and other HR relations.

Audits and monitors all Enrollment processes and individual partner performance to assure compliance with department policies and procedures, State, Federal, and NCQA guidelines, as well as contracted health plan directives.

Assists in overseeing collaboration between Enrollment, Medical Staff Office and Revenue Cycle to ensure effective communication regarding new providers. Ensures timely communication with operational leaders on status of enrollment approvals. Provides reports as necessary for Patient Accounts, Patient Access, etc. with enrollment confirmation information necessary for timely billing.

Obtains and maintains information necessary for credentialing Mercyhealth providers with laboratory certification with the Illinois Department of Public Aid, as applicable. Monitors expiration dates and updates to ensure claims are paid in a timely manner. Responsible for... For full info follow application link.

EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Action Plans.

APPLICATION INSTRUCTIONS:
Apply Online:

ipc.us/t/0545DD876F354B2E

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