Under the direction of the Executive Director, the Provider Enrollment Manager is responsible for the daily activities of a team of Provider Enrollment Specialists, focused on commercial and government payor enrollment activity for the assigned market(s). The Manager coaches and empowers the team providing resources to work independently.

Responsibilities

• Ensure that the department is up to date regarding current payor enrollment requirements and processes to minimize enrollment delays. This includes policy and process documentation. • Ensure the timely submission and follow up of enrollment with the payers to ensure that each provider is billing ready upon the commencement of their employment. • Ensure the timely submission of re-credentialing documentation for each provider. • Actively and continuously analyzes workflows, organizational structure, staffing assignments or other factors to ensure optimal performance; makes recommendations and modifications, as necessary. • Provide clear direction for staff by establishing goals, objectives, policies, procedures, performance improvement programs, and action plans as needed. Performs training, coaching, auditing and evaluations of Provider Enrollment staff. Supervises enrollment staff and workflow including guidance and training for staff • Oversee maintenance of Provider Enrollment Databases. Responsible for the timely updating in Payer portals, CAQH, and other applications as appropriate. • Effectively communicate with practice management the status of the providers with the third-party payers. • Staff training and development through supportive hands-on leadership • Workload management through planning, prioritizing, and assigning work according to shifting priorities • Report out on team’s productivity using custom reporting to Leadership • Monitor and actively participate in the monthly meetings and other operational revenue meetings • Audits payer websites for erroneous or missing provider profile data • Ensure the strategic plan, mission vision and values are communicated to the team and are integrated in its goals, objectives, and work in a positive manner. • Work with Leadership in developing new processes and procedures to improve quality and quantity of work. • Recognize and recommend operational improvement as needed • Assist with other departmental project assignments per management request

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.

Education

• Bachelor's Degree (Required) Education: Bachelor’s degree in Business office Administration, Health Care Management or related field preferred

Experience: 5-10 years of experience in a related field or an equivalent combination of education and experience.

Minimum 3-5 years of managerial experience in professional healthcare setting or health insurance plan provider enrollment setting required.

Experience with MDStaff and CAQH enrollment systems preferred

Comments: • Must possess strong verbal and written communication skills • Knowledge of third-party payer requirements and guidelines • Must possess strong analytical skills, accurate typing and computer skills, including Outlook, Excel and Word • Able to adjust to changes and adapt to new processes • Ability to research issues and to recommend feasible solutions • Advanced knowledge of and ability to use computers and related software including MS Excel spreadsheet, Word, and Email

Credentials

• No Certification, Competency or License Required

Work Schedule: Days

Status: Full Time Regular 1.0

Location: Northgate-400 Association Dr.

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Tamara B. Young tammy.young@vandaliahealth.org