Manager - Payer Contracting/ Provider Enrollment

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.

Manages the provider credentialing and payer contracting function to ensure physicians are credentialed with each commercial and government insurance company for the Physician Alignment division. Ensures staff maintains data on credentials of current staff as required. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview

Manages the provider credentialing and payer contracting function to ensure physicians are credentialed with each commercial and government insurance company for the Physician Alignment division. Ensures staff maintains data on credentials of current staff as required. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What You Will Do

• Coordinates, monitors, and completes the verification process for all physicians, practitioners, and nurses including an initial review of verifications. Ensures correct submission of credentialing application, necessary paperwork and tracking of provider initial and renewal credentialing application along the enrollment process for insurance credentialing.
• Maintains physician alignment provider database, insuring accurate and current provider information. Collects provider demographic and credentialing information from various sources related to the additions, changes and terminations necessary to maintain an accurate provider database. Updates physician alignment provider database with additions, changes and terminations. Manages the reporting requirements created by additions, changes and termination events, including notices to clients and/or payers for updates to their payer systems on a monthly bases. Creates and provides various ad-hoc physician demographics and participation reports on an as needed basis as requested by physician alignment, MLH departments and Metro-care physicians. Ensures provider data is validated for accuracy and submitted to ensure providers receive proper payment from insurance companies.
• Manages contract process for Physician Alignment; direct contracts, new business and existing contract renewals. Ensures practices and procedures are accurate and up-to-date with industry trends and current provider credentialing standards. Ensures an established contracting process is followed for the purpose of smooth implementation of provider contracts. Assists director with review for accuracy of contracting documents provided by major clients (Cigna, BCBS, and UHC, etc.) works with MLH finance and CBO to ensure smooth transition of renewals and new contracts. Notify all necessary MLH departments and personnel of new and updated contracts.
• May complete state medical license applications and renewals for physicians and mid-level providers, and perform follow-up with state medical licensure boards on status of license applications. Initiates the process for ensuring malpractice coverage and medical staff privileges for all contracted providers.
• Works with external consultant and CFO of physician alignment to communicate pricing demands and contracting issues with payers.
• Maintains and develops a competent, productive, and quality conscious workforce by hiring, evaluating performance, counseling, and training of department personnel according to the MLH value system.
  
  

Education/Formal Training Requirements

• High School Diploma or Equivalent
• Bachelor's Degree Business Administration/Management
  
  

Work Experience Requirements

• 3-5 years Credentialing
• 1-3 years Management
  
  

Licenses And Certifications Requirements

• Certified Professional Credentialing Specialist - National Association Medical Staff Services
• Certified Medical Professional Services Management - National Association Medical Staff Services
  
  

Knowledge, Skills And Abilities

• Stong understanding of the payer enrollment and credentialing processes, state licensing for TN, MS and AR, DEA, and NPI regulatory requirements.
• Strong knowledge of credentialing services principles, methods and procedures.
• Considerable knowledge of computer applications, utilizing databases, software for Provider Management, Payer Enrollment and credentialing.
• Ability to develop and maintain effective relationships with medical staff and other professionals.
• Strong verbal and written communication skills, responds to governmental audits and requests for information.
• Ability to perform thorough investigation and follow through on issue resolution with minimal management intervention.
• Ability to interact with insurance contacts, government and regulatory orgarizations and external medical staff departments.
  
  

Supervision Provided by this Position

• Manages Associates within division.
  
  

Physical Demands

• The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
• Must have good balance and coordination.
• The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
• The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
• The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.
  
  

Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Education

Bachelor's Degree: Business Administration/Management, High School Diploma or Equivalent (Required)

Work Experience

Credentialing, Management

Certifications

Certified Medical Professional Services Management - National Association Medical Staff Services, Certified Professional Credentialing Specialist - National Association Medical Staff Services

Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.