- Ensuring timely communication with Practice/implementation team to obtain necessary credentialing and provider enrollment information,
- Ensuring timely, efficient and accurate credentialing applications are submitted to contracted payers,
- Ensuring proper follow up on all credentialing applications submitted to obtain timely PAR status for providers,
- Manages all re-credentialing as necessary for contracted payers,
- Ensures timely "build" of provider enrollment information in Athena for all providers, practices and locations,
- Manages the daily operational needs of provider enrollment and credentialing to support RCM as related to billing and collections,
- Ensures accurate PAR list for all providers for contracted payers and provides PAR list to end users as necessary,
- Manages the daily operational needs and services related to the payer enrollment process and represents Balance Health interests to all types of payers including federal and state government agencies/programs, and commercial insurance carriers.
- Complete EFT and ERA authorization documents to enable payment between client and carrier
- Demonstrated ability to work effectively with different departments to affect positive change
- Assists with Departmental audits
- Directs all Regional Provider Enrollment and Credentialing daily tasks
- Assesses daily workload of team and distribute as appropriate
- Works closely with the RCM Leadership, Implementation and Operations to ensure the timely
- onboarding/credentialing/enrollment of new providers and the ongoing re- enrollment/validation of existing providers
- Responsible to develop, supervise and manage various enrollment/credentialing related
- initiatives, has direct supervision for Regional Provider Enrollment Coordinators and Credentialing Coordinators
- Expected to stay current with federal and state related enrollment/credentialing changes,
- participate in workgroups and focus groups, analyze/predict the potential impact on the organization and develop, implement and document processes to support any changes
- Other duties as assigned.
- Working knowledge of provider enrollment structure and processes
- Excellent organization abilities
- Excellent written and oral communication skills
- Creative and persistent problem solver
- Attention to detail and accuracy
- Client/service oriented (internal and external)
- Maintain strict confidentiality of sensitive information
- Ability to interact and communicate with individuals at all levels of organization
- Ability to multi-task and prioritize workload in a fast-paced environment
- Ability work in a group setting
- Must be self-motivated with the ability to complete projects independently within established timeframes
- Advanced understanding/knowledge of computer data entry, Microsoft Excel and ability to navigate through any business-related software
- Proficient typing skills
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Regional Supervisor, Provider Credentialing - Concord, United States - Balance Health
Description
Job Description
Job DescriptionDescription:Position Summary:
Under supervision of the Credentialing Manager, serve as Supervisor of Credentialing, responsible for:
Essential Duties and Responsibilities:
Acts as a liaison with Medical Group leadership (ensuring provider cooperation and understanding of financial ramifications related to delayed or incorrect enrollment)
Prior experience must include management experience working in a highly automated environment and will be accountable for optimizing the quality and efficiency of the Provider Enrollment team
Responsible for ensuring the department possesses relevant knowledge of enrollment
requirements of various health plans and states
Oversees and directs all daily activities in support of the regional departmental goals and objectives, and is responsible for directing, motivating, monitoring, measuring and developing employees
Serves as the primary point-of-contact for day-to-day Provider Enrollment and Credentialing issues
Responds to and resolves unusual problems or delays in enrollment process (including claim
denials)
This role is a key member of the Credentialing Team with involvement in decisions affecting all other departments within Credentialing, and can be expected to generate and present to senior executive analysis and recommendations to enhance organizational effectiveness
Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities required in the role:
Open to candidates in Alabama, Arizona, California, Colorado, Florida, Hawaii, Illinois, Michigan, Nevada, North Carolina, South Carolina, Texas, Virginia, and Wisconsin.
