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Role Description

This position is responsible for the overall management of the Provider Enrollment department which includes developing and improving operational goals, staffing, training, quality assurance and development of staff. Oversees day-to-day activities of the provider enrollment process to ensure the managed care, Medicare and Medicaid status of all NPH providers is and remains current. This includes obtaining and maintaining provider numbers, coordinating with managed care plans to obtain provider numbers and enrolling providers in managed care and government plans. Administers the provider enrollment system to ensure the process workflow is as efficient as possible. The Provider Enrollment Specialists report to this position.

Essential Duties and Responsibilities:

• Manage the daily activities of the enrollment team; hiring and training, ensuring compliance with policies and procedures, counseling employees both ongoing and as part of the annual review process, ensure performance standards are achieved; approve time off and ensure staffing assignments align with the business needs of the company.
• Mentor employees, counsel and provide disciplinary actions to assigned personnel, and work to facilitate individual and team development that drives positive results.
• Troubleshoot issues and provide technical support for their team.
• Facilitates daily workflow assignments to ensure all areas are covered. Strategically assigns representatives based on skills and aptitude.
• Responsible for maintaining adequate staffing levels in the department and interviewing job applicants.
• Create and communicate management goals and objectives to team.
• Collaborates activities between departments to ensure no breakdown in the enrollment process.
• Analyzes and prepares reports on trends in the enrollment process.
• Responsible for developing benchmarks and performance metrics for the team and implementing the initiatives of the company’s goals and objectives.
• Develop and implement policies and procedures to ensure enrollment process functions at high service levels.
• Work closely with leaders in the areas of RCM, Operations, Finance, Human Resources, Information Systems, Managed Care and Compliance to achieve business objectives and implement organizational strategy.
• Ensures applications are properly verified and accurately loaded into database system.
• Administers the enrollment system to ensure information kept in the system is tracked appropriately and that the system workflow is sufficient to ensure proper service levels.
• Coordinates all provider enrollment activities for current and potential providers to ensure that provider numbers and required documents are always current.
• Responsible for collaboration between departments regarding provider enrollment issues and/or concerns.
• Process applications for government and managed care entities; contacts providers regarding missing information when necessary.
• Ensures the data integrity of the enrollment system.
• Ensures that the enrollment system is fully utilized, maintained and kept up-to-date.
• Conducts audits to ensure the provider enrollment process is efficient.
• Generates reports and queries reporting results to Management.
• Reviews all applications and other provider enrollment information for thoroughness and completion prior to being sent to government entities, managed care plans or internal department and management.
• Continually instills and maintains the highest level of customer service within the department.
• Participates in identification, development and implementation of systems to improve efficiency in the registration process.
• Maintains close contact with division heads, providers, administrators, managed care department and internal departments regarding status of applications and provider enrollment process.
• Work closely with Physician Recruiter and Human Resources to maintain accurate status of all recruits.
• Maintains provider files and provider enrollment documentation.
• Continually identifies process improvement methods and ways to automate processes to increase efficiency.
• Provides interface with other NPH departments, off-site locations as needed.
• Adhere to all company policies and procedures.
• Adherence to and compliance with information systems security is everyone’s responsibility.
• Maintain employee timecards and payroll tasks.
• Monitor employee Paid time off process.
• Partner with Human Resources on any programs throughout the year: Performance Management, Merit Process, etc.
• Perform other duties as assigned.

Qualifications

• Bachelor’s degree in business administration, Healthcare, or related area; or equivalent combination of education and experience.
• Associate’s degree and experience combination will be considered.
• 5 years’ experience in healthcare industry with upward mobility documented.
• 3 years provider enrollment and revenue cycle experience.
• 3 - 5 years of supervisory and/or leadership experience required.
• Prefer 2 years Anesthesia experience.
• Extensive knowledge of Medicare, Medicaid, Sam’s.gov, Department of Labor and commercial payer enrollment.
• Experience using PECOS and CAQH.
• Strong understanding of NPI taxonomy, TIN structures, and group billing.
• Proficiency in Microsoft Office Suites and tracking/reporting tools.
• Experience in multi-state enrollment.
• Experience working in fast paced, high-growth healthcare organizations.
• Familiarity with credentialing software platforms.

Requirements

• Working knowledge in the process of enrolling and/or credentialing physicians and ancillary providers.
• Working knowledge in provider enrollment process.
• Knowledge in revenue cycle process.
• Knowledge of managed care.
• Knowledge of government entities (Medicare and Medicaid).
• Demonstrated ability to work cooperatively with physicians, all staff members and external customers.
• Strong analytical and problem-solving skills to identify trends and issues and ability to provide solutions to address issues.
• Ability to work effectively with staff, physicians and external customers. Must display teamwork attitude and good inter-personal skills.
• Ability to meet deadlines.
• Working knowledge of computers and ability to use word-processing, spreadsheet and database programs.
• Strong attention to accuracy and detail.
• Exceptional organizational skills and multi-tasking skills.
• Ability to communicate effectively, both in writing and verbally.
• Knowledgeable in Federal and State Regulation on Confidentiality.
• Self-motivated; ability to work without direct supervision.
• Must have a pleasant disposition and high tolerance level for diverse personalities.
• Ability to supervise numerous employees effectively.
• General knowledge of the procedures of other departments and their relationship to the Credentialing, Provider Enrollment and Revenue Cycle Departments.
• Skill in gathering, reporting and analyzing information.
• Ability to motivate diverse personalities.

Benefits

• Quoted pay ranges are not guarantees of what final salary offers may be.
• Base pay is based on market location and will vary depending on job-related knowledge, skills, and experience.
• Base pay is only one part of the Total Rewards that NPH provides to compensate and recognize our staff for their work.
• Full time positions are eligible for a discretionary bonus and a comprehensive benefits package.