1 Provider Enrollment & Maintenance Supervisor (Remote Option) Job in Elkin, NC
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Provider Enrollment & Maintenance Supervisor (Remote Option)
$53k-67k (estimate)
Full Time | Ambulatory Healthcare Services
3 Weeks Ago
Partners Health Management is Hiring a Remote Provider Enrollment & Maintenance Supervisor (Remote Option)
Competitive Compensation & Benefits Package! Position eligible for –
Office Location: Negotiable for any of our office locations; Remote Option
Projected Hiring Range : Depending on Experience
Closing Date : Open Until Filled Primary Purpose Of PositionThis position assists in the maintenance, development and management of the provider network for consumers who have been identified as having mental health, substance abuse or intellectual development disability needs.
Role And ResponsibilitiesA Provider Enrollment & Maintenance Supervisor’s primary duties may be one or more of the following:
Education/Experience Preferred: Healthcare Management degree or certification, Certified Provider Credentialing Specialist (CPCS) and/or Registered Healthcare Information Technician (RHIT) preferred.
- Annual incentive bonus plan
- Medical, dental, and vision insurance with low deductible/low cost health plan
- Generous vacation and sick time accrual
- 12 paid holidays
- State Retirement (pension plan)
- 401(k) Plan with employer match
- Company paid life and disability insurance
- Wellness Programs
Office Location: Negotiable for any of our office locations; Remote Option
Projected Hiring Range : Depending on Experience
Closing Date : Open Until Filled Primary Purpose Of PositionThis position assists in the maintenance, development and management of the provider network for consumers who have been identified as having mental health, substance abuse or intellectual development disability needs.
Role And ResponsibilitiesA Provider Enrollment & Maintenance Supervisor’s primary duties may be one or more of the following:
- Provides direct supervision to enrollment and maintenance staff including, recruiting, hiring, training and providing disciplinary action to individuals as needed;
- Performs day to day duties of assuring that providers (individual, group, ancillary, etc.) are set up accurately in the provider information system for state reporting, claims payment, and directories.
- Oversees enrollment of providers into the Partners Network according to parameters determined for qualifications and needs of the Network;
- Oversees request of providers to join the Partners Network according to parameters determined for qualifications and needs of the Network;
- Oversees the completion of routine and ongoing site/service additions requests to ensure that services are consistent with funding requirements, best practices, provider contracts and federal/state rules and regulations;
- Attention to detail and adherence to strict timelines is essential to the success of this position;
- Must be able to work independently and use good judgement in making critical decisions that impact service availability inside the Partners network;
- Obtains and maintains time sensitive confidential provider information;
- Must have a good working knowledge of the state CVO (Credentialing Verification Organization) system and processes;
- Tracks on enrollment activities and ensures timely and accurate data entry by enrollment staff;
- Is responsible for responding to inquiries from providers and internal staff related to the status of enrollment and change requests;
- Is responsible for working claim denials related to provider profile set-up;
- Interprets audit results, identifies trends/patterns that impact service/system quality, and then implements interventions aimed at addressing these trends/patterns with the outcome of services delivery to consumers at the highest degree of quality;
- Communicates clearly and effectively with providers, external stakeholders and internal staff on a regular basis;
- Coordinate Provider Network information for publication on the Partner’s website with Communications Officer.
- Compose letters, memos and emails to internal and external contacts. This includes time sensitive enrollment status letters.
- Serves as a liaison and a resource to other departments within the LME/MCO and with various NC DHHS Departments, per rule requirements, to coordinate enrollment and maintenance activities;
- Works closely with IT and Public Relations to maintain the Provider Search Tool;
- Participates in Provider Forums as requested and provides technical support and assistance to Provider Councils as needed;
- Participates in oversight and monitoring reviews of the MCO;
- Develops and maintains policies and procedures related to provider enrollment and maintenance.
- Considerable knowledge of the laws, regulations and policies that govern the program
- Exceptional interpersonal and communication skills
- Strong problem solving, negotiation, arbitration, and conflict resolution skills
- Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint
- Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements
- Ability to make prompt independent decisions based upon relevant facts
- Ability to establish rapport and maintain effective working relationships
- Ability to act with tact and diplomacy in all situations
- Ability to maintain strict confidentiality in all areas of work
Education/Experience Preferred: Healthcare Management degree or certification, Certified Provider Credentialing Specialist (CPCS) and/or Registered Healthcare Information Technician (RHIT) preferred.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Ambulatory Healthcare Services
SALARY
$53k-67k (estimate)
POST DATE
06/08/2024
EXPIRATION DATE
07/06/2024
WEBSITE
partnersbhm.org
HEADQUARTERS
GASTONIA, NC
SIZE
200 - 500
FOUNDED
2012
CEO
RHETT MELTON
REVENUE
$10M - $50M
INDUSTRY
Ambulatory Healthcare Services
Related Companies
About Partners Health Management
Partners Health Management is the local manager of mental health, substance use disorder, and intellectual and developmental disabilities treatment available through Medicaid, state, and county funding. We contract with care providers to ensure that treatment options are available for eligible residents of Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Rutherford, Surry, and Yadkin counties. Our Crisis Line is available all day, every day at 1-888-235-HOPE (4673). Learn more about us at www.PartnersBHM.org.
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