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Mgr. Provider Enrollment

Company: Palmetto Health
Location: Greenville
Posted on: May 3, 2021

Job Description:

Inspire health. Serve with compassion. Be the difference.

Job Summary

Responsible for planning, organizing, and leading functions of enrollment for all of Prisma Health including Managed Care credentialing and facility credentialing for Prisma Health. Responsibility includes all physicians and APPs for PH University Medical Group and Prisma Health Midlands as well as all Prisma Health Upstate and Prisma Health Midlands faciltiies. Leads team that completes complex facility applications and issue resolution. Works closely with Operational Leaders and Revenue Cycle Leaders to identify, recommend, develop, implement and support process improvement. Oversight of Echo Credentialing database and ensuring team is adhering to standards set forth and staying in compliance with NCQA guidelines and payor contracts.

Accountabilities

  • TECHNOLOGY- Oversight and/or maintenance of Epic Database. Payor Enrollment and Epic Billing system credentialing edits/denial work ques. Managing applications ensuring issues are triaged and resolved in a timely fashion. - 15%

  • TRAINING- Responsible for all aspects of training, Epic Work ques, Managed Care Credentialing, Rosters, Echo, Workflows and other internal processes. Maintain materials in our One Note Provider Enrollment Manual. Monitor volumes in work ques and reassign duties as needed. - 5%

  • FINANCIAL- In conjunction with Directors, leads and provides oversight in operational services associated with revenue cycle including Changes of Ownership and Name Changes to insure successful claims adjudication. Oversee the development of tracking tools to analyze data to identify claim trends to ensure responsible decision making. Oversight of all claim hold work ques to ensure claims are moving out successfully. - 10%

  • POLICY & PROCEDURE- Manage the development and implementation of policies and procedures to ensure effective operations. Direct the development of standards of performance and mechanisms for problem resolution. Responsible for compliancy with governmental payor standards and NCQA standards. - 10%

  • PROJECT MANAGEMENT - Plans, supports, and coordinates activities to ensure that goals and objectives of project are accomplished within prescribed time frame and funding parameters. Reviews project proposal or plan to determine time frame, funding limitations, procedures for accomplishing project, staffing requirements, and allotment of available resources. - 15%

  • PERSONNEL MANAGEMENT -Recruitment and hiring of departmental staff members. Develop a departmental staff training program to ensure all employees understand departmental and Prisma Health policies and procedures. Research current education and training needs, monthly rounding. - 10%

  • COMMUNICATION - Establish sound working relationships and cooperative arrangements with all of Prisma Health Revenue Cycle, MSO and CVO departments and executives. Lead and oversee Prisma Health Physician/Provider onboarding and special programs. - 10%

  • Serve as the Authorized Official within the Governmental Identity and Access System. Assign surrogate privileges to appropriate Prisma Health employees. Serve as Delegated Official on behalf of Prisma Health within the Governmental Medicare and Medicaid System. Signs on behalf of Prisma Health along with CEO, CFO, COO and Executive Director of Revenue Cycle. - 10%

  • Serve as an enrollment subject matter expert for all functions including managed care credentialing, facility credentialing and credentialing Epic work ques. Serve an active role in planning successful implementation of programs in conjunction with Prisma Health departments. Called upon to participate in meetings to advise about proper procedures and processes required in order to acquire revenue for services rendered by Prisma Health facilities and providers. Lead team to successfully leading monthly enrollment calls with our payors to resolve outstanding issues and confirm provider/locations loaded at payor. - 10%

  • AUDITS- Conduct weekly audits on provider enrollments including locations reviewing information in Echo compared to analysts applications, ensuring accuracy prior to submission. Also, includes facility credentialing applications. - 5%

Supervisory/Management Responsibilities

Job has direct and/or indirect supervision of team members that may include final budget authority, hire/termination authority, performance appraisal responsibility and disciplinary authority. Job will be considered a member of management staff at Prisma Health or affiliate and will have direct reports.

Minimum Requirements

  • Bachelor's Degree - Business or Health Care Administration

  • 5 years - Healthcare, Revenue Cycle, Enrollment, Payor Experience. Minimum 2 years of supervisory or management experience.

Knowledge, Skills or Abilities

  • Basic computer skills

  • Knowledge of office equipment (fax/copier)

  • Proficient computer skills (word processing, spreadsheets, database)

  • Data entry

  • Mathematical skills

  • Governmental enrollment experience

  • Epic follow-up and claim edit work ques - preferred

  • Revenue Cycle experience - preferred

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

1001 Corporate Services - Upstate

Department

70019224 Provider Enrollment

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

Keywords: Palmetto Health, Greenville , Mgr. Provider Enrollment, Other , Greenville, South Carolina

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