Position Summary: Under supervision of the Director of Credentialing, serves as Supervisor of Credentialing, responsible for:

• Ensuring timely communication with Practice/implementation team to obtain necessary credentialing and provider enrollment information.
• Ensuring timely and accurate load of provider information into athenaHealth.
• Ensuring timely, efficient and accurate credentialing applications are submitted to contracted payers.
• Ensuring proper follow up on all credentialing applications submitted to obtain timely PAR status for providers.
• Manages necessary updating of information in athenaHealth to ensure all provider information is updated and available.
• Manages all re-credentialing as necessary for contracted payers.
• Ensures timely “build” of provider enrollment information in Athena for all providers, practices and locations,
• Manages the daily operational needs of provider enrollment and credentialing to support RCM as related to billing and collections.
• Ensures accurate PAR list for all providers for contracted payers and provides PAR list to end users as necessary,
• Manages the daily operational needs and services related to the payer enrollment process and represents Balance Health interests to all types of payers including federal and state government agencies/programs, and commercial insurance carriers.

Essential Functions:

Acts as a liaison with Medical Group leadership (ensuring provider cooperation and understanding of financial ramifications related to delayed or incorrect enrollment).

Prior experience must include management experience working in a highly automated environment and will be accountable for optimizing the quality and efficiency of the Provider Enrollment team.

Responsible for ensuring the department possesses relevant knowledge of enrollment requirements of various health plans and states.

Oversees and directs all daily activities in support of the regional departmental goals and objectives, and is responsible for directing, motivating, monitoring, measuring and developing employees.

Serves as the primary point-of-contact for day-to-day Provider Enrollment and Credentialing issues.

Responds to and resolves unusual problems or delays in enrollment process (including claim denials).

This role is a key member of the Credentialing Team with involvement in decisions affecting all other departments within Credentialing, and can be expected to generate and present to senior executive analysis and recommendation to enhance organizational effectiveness.

Responds to credentialing unbilled problems as indicated by “holding report”.

Complete, submit, and tracks Clearinghouse applications for Claim Submission (EDI) and Electronic Remittance Advice (ERA).

Complete EFT and ERA authorization documents to enable payment between client and carrier.

Demonstrated ability to work effectively with different departments to affect positive change.

Creates enrollment policies and procedures as needed.

Assists with Departmental audits.

Directs all Regional Provider Enrollment and Credentialing daily tasks.

Assesses daily workload of team and distribute as appropriate.

Leads weekly Team Meetings to ensure all functions are being completed in a timely manner and provides guidance and coaching as needed.

Works closely with the RCM Leadership, Implementation and Operations to ensure the timely onboarding/credentialing/enrollment of new providers and the ongoing re- enrollment/validation of existing providers.

Responsible to develop, supervise and manage various enrollment/credentialing related initiatives, has direct supervision for Regional Provider Enrollment Coordinators and Credentialing Coordinators.

Expected to stay current with federal and state related enrollment/credentialing changes, participate in workgroups and focus groups, analyze/predict the potential impact on the organization and develop, implement and document processes to support any changes.

Other responsibilities as assigned.

To be successful in this role an individual must be able to perform all essential functions satisfactorily above and meet the qualifications outlined below:

QUALIFICATIONS: [Education, Training, Knowledge, Skills, Abilities, and Expected Behaviors]

• 5 years in a healthcare payer enrollment experience AND credentialing/onboarding within a multi-specialty, medical group, government enrollment experience is required.
• 3 years of leadership/management experience, managed care setting preferred.
• Experience in working with Government agencies, CMS and AHCA preferred.
• Bachelor’s degree in Health Care Administration, or related field, Experience Considered
• Certified Provider Credentialing Specialist (CPCS) preferred
• Working knowledge of provider enrollment structure and processes
• Excellent organizational abilities
• Excellent listening, written and verbal communication skills
• Creative and persistent problem solver
• Attention to detail, ensuring accuracy
• Client/service oriented (internal and external)
• Understands and ensures strict confidentiality of sensitive information is maintained
• Ability to interact and successfully communicate with individuals at all levels within the company
• Ability to multi-task and prioritize workload in a fast-paced, constantly changing environment
• Able to work in a group setting
• Must be self-motivated with the ability to complete projects independently within established timeframes
• Advanced understanding/knowledge of computer data entry, Microsoft Excel and ability to navigate through any business-related software
• Highly PC Proficient with good working knowledge of Microsoft Office, including Word, Excel, and Outlook, database systems, organizational chart programs, and report generation. Experience with SmartSheets or able to easily learn.
• Legal eligibility to work in the United States without sponsorship now or in the future.
• Ability to successfully pass an in-depth background investigation, including a credit check and with a clean DMV report.

Open to candidates in Alabama, Arizona, California, Colorado, Florida, Hawaii, Illinois, Michigan, Nevada, North Carolina, South Carolina, Texas, Virginia, and Wisconsin.