Provider Enrollment Manager
2 days ago
The Provider Enrollment Manager is responsible for overseeing the daily operations of UH Corporate Provider Enrollment functions. This role provides leadership and support for the Provider Enrollment Team, managing all aspects of employee engagement and performance, and audits the team's quality of work to ensure proper accountability, assignments, and completion of work tasks timely in accordance with established goals and metrics.
Key Responsibilities
- Oversee and manage all aspects of the provider enrollment process.
- Monitor provider holds by prioritizing a focus on clients with large dollars impacted and resolve these issues.
- Effectively work with vendors to identify any issues that might have an impact on revenue flow and communicate this to revenue cycle, managed care, and senior leadership of PE in a prompt and timely manner.
- Under the direction of the Director of Medical Staff Services, Credentialing, & Provider Enrollment, draft new policies, train and retrain employees/vendors, rectify errors, and monitor ongoing compliance with policies.
- Maintain audit results and report these to the manager of the department.
- Continuously work with revenue cycle, managed care, physician services, UHMP, UHMG, UHRP, and UHUC provider offices, practices, group administrators, and medical staff services members while acting as the nucleus for systematic success.
- Ensure quality accounts receivable results by achieving or exceeding customary key performance indicators, such as claims held/released for the department.
- Manage provider enrollment team resources and workflow to reach maximum efficiency and productivity levels, as well as provide solutions on how to improve in this area.
- Review and identify insurance carrier trends related to each team member's assigned specialties and resolve any related revenue and enrollment issues.
- Report all identified enrollment, carrier, and revenue-impacted trends and issues to the Director and Manager of Medical Staff Services, Credentialing, & Provider Enrollment.
- Work with other departments (i.e., CBO, managed care, IT) to minimize and/or resolve ongoing procedural problems affecting continuity of patient care, provider services rendered, and quality standards.
- Promptly inform the Director of Medical Staff Services, Credentialing, & Provider Enrollment of any matters that may cause a disruption to revenue or the continuity of patient care.
- Bachelor's Degree (Required) and Master's Degree (Preferred)
- 5+ years related experience (Required) and 3+ years management experience in which problem-solving and research were major keys to success (Required) and 2+ years experience in personnel management (Required)
- Enhanced knowledge of provider enrollment processes and requirements for commercial insurance companies, CMS Federal and State Guidelines related to enrollment and reenrollment policies (Preferred proficiency)
- Knowledge of accounts receivable and revenue cycle management (Preferred proficiency)
- Familiar with group and provider documents, i.e., medical licenses, medical school practices, board certifications, etc. (Required proficiency)
- Project management (Required proficiency)
- Advanced presentation skills (Required proficiency)
- Conflict resolution skills (Required proficiency)
- Experience and knowledge with payor issues that result in resolutions (Required proficiency)
- 10%
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