Manager Provider Enrollment - HP Enrollment Eligibility

Summary:

The Provider Enrollment Manager is a leadership position that provides support, direction, and focus for the Provider Enrollment staff. This Job is responsible for the staffing, and management of daily activities to produce successful outcomes of enrolling onboarding providers with payers. The Provider Enrollment Manager ensures that information is processed accurately and appropriately, trains staff on organizational policies and ensures policies are followed at all times and provides guidance to staff on more complex enrollment or audit issues. This Job measures productivity and outcomes. Managers are expected to monitor adherence and compliance to CHRISTUS standards, directives, regulatory requirements and other guidance that mandates requirements governing such processes. This Job also works to ensure that the provider enrollment and credentialing requirements are in line with our policies and procedures as well as our contracted payer requirements. The Enrollment Manager is expected to maintain effective professional relationships with other department leadership, share ideas, and implement actions related to the Provider Enrollment functions. The ability to communicate effectively with all types of people at all levels is critical. This Job is expected to provide the leadership needed to promote a teamwork environment. Numerous regulatory requirements are included in all these processes and Management is expected to monitor for Compliance.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Ensures that areas within the Provider Enrollment functions are directionally aligned with CHRISTUS.
• Develops daily workflow monitoring for areas of responsibility and staffs to meet the needs of the organization.
• Responsible for the outcomes of the performance initiatives and supports the metrics outlined for performance measurements.
• Coordinates the development and professional growth of the direct reports.
• Ensures success of the provider enrollment lifecycle by monitoring client level metrics as well as ensuring timeliness and accuracy of team's enrollment activities related to new enrollment, reenrollment, enrollment denials and client level special projects
• Makes recommendations on work-flow processes throughout the enrollment cycle to assist in achieving consistency and success
• Develops and makes recommendations on policies, guidelines, and implements procedures to ensure consistent department-wide implementation and adherence
• Monitors timeliness and effectiveness of department activities, implements processes to identify and eliminate gaps
• Works collaboratively with operations and regional Leadership to ensure goals and objectives are achieved.
• Responds to organizational and customer's needs with innovative processes to ensure service excellence.
• Leads and collaborates informed direction, and cooperation on a variety of divisional decisions regarding operation solutions and services.
• Ensures compliance with relevant regulations, standards, and directives from regulatory.
• Prepares and presents performance reports to Leadership, and others as necessary.
• Assures that high performance work team is developed through coaching, mentoring and weekly huddles.
• Collaborates with other system departments, regions, and managed care payers to ensure business process improvement initiatives meet stated deadlines.
• Leads the enrollment team into a high-performing department through routine measurement review of high priority metrics.
• Develops and implements plans based on regulatory, business, and client requirements, including infrastructure requirements, business application solutions, operations and service deployment.
• Knowledge of general Federal and applicable State regulatory environment related to managed care credentialing activities as appropriate.
• Performs other duties as assigned.

Job Requirements:

Education/Skills

• A Four-year bachelor's degree or equivalent experience required

Experience

• At least 4 years' experience in credentialing payer & provider enrollment for an insurance company, hospital, or other large provider organizations
• At least 2 years' experience managing staff & building department policies and procedures
• Experience navigating payer enrollment and credentialing issues with managed Medicare, Medicaid, and commercial health plans

Licenses, Registrations, or Certifications

• None

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time