Provider Enrollment Manager

Location :   Bedford, MA; Remote in AL, FL, GA, MI, MO, NC, NH, OH, OK, TN, TX, WI, AND WV

Purpose

The Manager, Provider Enrollment is responsible for assigned functions and oversight of daily operations. The Manager, Provider Enrollment oversees process, work and performance of team members (stateside and international). This position provides leadership and support for the Provider Enrollment team managing all aspects of employee engagement, performance, quality, and ensures accountability and equitable distribution of work. The Manager is a member of the Provider Enrollment Leadership team and is responsible for workflow development, action planning, and other departmental initiatives.

Duties and Responsibilities

Team Leadership : supervise and provide guidance, coaching, and performance management to provider enrollment teammates

Enrollment Process Management : Organize, oversee and manage all aspects of provider enrollment processes

Relationship Management : Build and maintain effective relationships with internal and external stakeholders

Meeting Management

Vendor Management-Identify opportunities to leverage vendors, ensure training, auditing, and management of vendor performance

Compliance : Maintain strict adherence to organization and department policies and stay abreast of payer regulations, enrollment requirements, and industry best practices

Process Improvement : Identify opportunities for process improvement and efficiency enhancements

Reporting and Analytics : utilize reports, dashboards, and other data sources to analyze enrollment data to track performance metrics and proactively identify trends

Critical Thinking and Communication : Identify and concisely communicate any matters that may lead to enrollment and / or cash flow delays or losses

Department Support : Lead, participate, and engage in department initiatives, that may be outside of the scope of day-to-day responsibilities

Comply with all State and Federal Laws regarding an effective Compliance Program inclusive of HIPAA Privacy and Security

Adhere to the Code of Conduct and be familiar with all compliance policies and procedures stored in Company intranet relevant to this position

Ensure departmental employees follow the Code of Conduct, compliance policies and procedures

Administer the appropriate sanction when an employee violates a compliance policy or procedure

Qualifications

To perform this job successfully, an individual must be able to perform each duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and / or ability required. Reasonable accommodation may be made to enable individuals with disabilities perform the duties.

Education (Degrees, Certificates, Licenses, Etc.)

Bachelor’s degree preferred.

Computer Skills

Familiar with Office 365 at an intermediate or above level.

Experience

5 years of related experience

3 years management experience in critical thinking, problem solving and research

2 years experience in personnel management with diverse and remote teams required

Group enrollment, multi-specialty and multi-state provider enrollment experience preferred

Proficiency with enrollment software and payer portal databases (PECOS, CAQH, NPPES)

Provider enrollment specialist certificate (PESC) preferred

Specific Job Knowledge, Skill and Ability

Intermediate knowledge of provider enrollment processes and requirements for federal, state, and commercial payers

Ability to concisely summarize issues, create timelines, and prepare scenarios of escalation to leadership, payers, legal, etc.

Ability to manage issues to resolution

Knowledge of revenue cycle processes

Possesses advanced presentation skills

Demonstrates critical thinking

Possesses project management skills

Ability to work both autonomously and as part of a team

Possesses conflict resolution skills

Excellent customer service, written and verbal communication skills

Ability to communicate effectively verbally and in writing

Ability to apply common sense understanding to carry out instructions

Specific vision abilities required by this job include close vision

Ability to sit for prolonged periods of time, use hands, talk, hear and occasionally walk and reach with hands or arm

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