Provider Enrollment Manager (Remote)

A Brief Overview

The Manager, Provider Enrollment is responsible for assigned functions and oversight of the daily operations of UH Corporate Provider Enrollment functions. The Provider Enrollment Manager is responsible for the overall management and administration of the provider enrollment processes for all clients. As well as oversee process, work and team members during the execution of the enrollment process, this position provides leadership and support for the Provider Enrollment Team managing all aspects of employee engagement and performance, and audits the team's quality of work to ensure proper accountability, assignments, and completion of work tasks timely in accordance with established goals and metrics. This position coordinates development of system-wide Policies and Procedures, action plans, work flows, and audit reports related to Provider Enrollment. Under the supervision of the Director of Medical Staff Services, Credentialing, & Provider Enrollment and in addition to the duties outlined below , this position Functions as an agent of the protected peer review process and remains current with appropriate internal and external requirements for performing the duties with the highest level of quality and compliance. The Manager, Provider Enrollment is a member of the departmental leadership team and is responsible for maintaining and developing relationships with UHMP/UHMG/UHRP/UHUC practitioners and other administrative leaders.
What You Will Do

• Oversees and manages all aspects of the provider enrollment process.
• Monitors provider holds by prioritizing a focus on clients with large dollars impacted and get these resolved.
• Effectively works with the vendors to identify any issues that might have an impact on revenue flow and effectively communicate this to revenue cycle, managed care, and senior leadership of PE in a prompt & timely manner.
• Under direction of the Director of Medical Staff Services, Credentialing, & Provider Enrollment, drafts new policies, trains and retrains employees/vendors, rectifying errors, and monitoring ongoing compliance with policies.
• Maintains audit results and report these to the manager of the department.
• Continuously and effectively works with revenue cycle, managed care, physician services, UHMP, UHMG, UHRP and UHUC provider offices, practices, group Administrators, and medical staff services members while acting as the nucleus for systematic success.
• Ensures quality accounts receivable results by achieving or exceeding customary key performance indicators, such as claims held/released for the department.
• Manages provider enrollment team resources and workflow to reach maximum efficiency and productivity levels, as well as provides solutions on how to improve in this area.
• Reviews and identifies insurance carrier trends related to each team members assigned specialties and resolve any related revenue and enrollment issues.
• Report all identified enrollment, carrier and revenue impacted trends and issues to the Director and Manager of Medical Staff Services, Credentialing, & Provider Enrollment.
• Works with other Departments (i.e. CBO, managed care, IT) to minimize and/or resolve ongoing procedural problems affecting continuity of patient care, provider services rendered, and quality standards.
• Promptly informs the Director of Medical Staff Services, Credentialing, & Provider Enrollment of any matters that may cause a disruption to revenue or the continuity of patient care.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Qualifications:
Education

• Bachelor's Degree (Required) and
• Master's Degree (Preferred)

Work Experience

• 5+ years related experience (Required) and
• 3+ years management experience in which problem solving and research were major keys to success. (Required) and
• 2+ years experience in personnel management (Required)

Knowledge, Skills, & Abilities

• Enhanced knowledge of provider enrollment processes and requirements for commercial insurance companies, CMS Federal and State Guidelines related to enrollment and reenrollment policies, (Preferred proficiency)
• Knowledge of accounts receivable and revenue cycle management, (Preferred proficiency)
• Familiar with group and provider documents, i.e. medical licenses, medical school practices, board certifications, etc. (Required proficiency)
• Project management (Required proficiency)
• Advanced presentation skills (Required proficiency)
• Conflict resolution skills (Required proficiency)
• Experience and knowledge with payor issues that result in resolutions. (Required proficiency)

Physical Demands

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely 20 lbs
• Carrying Rarely 20 lbs
• Pushing Rarely 20 lbs
• Pulling Rarely 20 lbs
• Climbing Rarely 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently

Travel Requirements

• 10%