Supervisor-Payer Enrollment

Overview

Job Summary

Under direction of the Payer Enrollment Manager, this position is responsible for the direct supervision of day to day

operations as well as continuing to perform provider enrollment and credentialing activities as necessary.

Minimum Requirements

Experience - Minimum of 3 years focused experience in credentialing/ payer enrollment

Education - High School/ GED and relevant combination of education and experience

Special Skills - Experience with provider enrollment processes, policies and procedures, including delegated credentialing requirements

Preferred/Desired

Experience - Team Lead or Supervisory experience Background in Medical Billing, knowledge of CPT/ ICD 10

Training - Proficient in the use of Microsoft products in a Windows operating system, to include but not limited to: Word, Outlook,

PowerPoint, Excel, Visio Type minimum of 35 wpm

Special Skills - Requires exceptional critical thinking skills, sound judgment and the ability to communicate in an articulate and sensitive

manner with practitioners, administrators, legal counsel and client credentialing personnel. Demonstrated effective analytical skills needed to assess compliance, record, analyze and interpret data into meaningful formats Ability to manage multiple projects efficiently and accurately. Demonstrated commitment to excellent customer service in order to maintain and ensure effective working relationships with internal and external clients

Job Responsibilities

• Communication
  
  

1.1 Participates in the development, implementation, and ongoing review of departmental policies and procedures.

1.2 Acts as a liaison between the Payer Enrollment department and the System EDI department to ensure that our department gives the system the

appropriate support

1.3 Meets with department manager regularly to effectively communicate and resolve issues, set and prioritize goals and improve processes

1.4 Coordinates and supervise special provider enrollment projects as needed

1.5 Assists with staff communication

• Enrollment/ Credentialing
  
  

2.1 Responds to internal and external inquiries on routine enrollment and contract matters

2.2 Processes applications for provider enrollment and credentialing/ re-credentialing activities as necessary

2.3 Processes applications for provider enrollment and credentialing/ re-credentialing activities as necessary

2.4 Works with identified team member to build out new locations or new office assignments and communicates to the team regarding the necessary

updates

2.5 Monitors status of changes of information (examples include but are not limited to new office affiliations, new TIN affiliation, provider name

changes)

2.6 Monitors status of newly assigned providers and escalates concerns per department protocols

• Oversight of Credentialing WQ
  
  

3.1 Monitors WQ response times

3.2 Creates tip sheets for handling of claims sent to the credentialing WQ's

3.3 Assists in oversight of credentialing WQ's and ensuring proper claims follow up

• SharePoint Maintenance
  
  

4.1 Oversees upload of updated credentialing/ payer enrollment SharePoint documents

• Accountability of Direct Report
  
  

5.1 Performs one on one meetings with directly reporting team members on a regular basis

5.2 Escalates concerns to management as appropriate

5.3 Performs annual review of directly reporting team members

Employee Attendance

6.1 Approves payroll on a biweekly basis making a note of any occurrences

6.2 Reviews PTO requests for approval

6.3 Documents occurrences and communicates status to team member

6.4 Communicates concerns to management as appropriate