Job SummaryUnder administrative direction, the Director of Provider Enrollment is responsible for the strategic leadership and operational oversight of the Provider Enrollment function, including team performance, day-to-day enrollment activities, and the effective delivery of provider enrollment services.
Essential Functions and Tasks- Directs, leads, and manages the Provider Enrollment department's day to day operations, recruits, selects, orients, trains, coaches, counsels, and disciplines staff
- Develops relationships with the Provider Enrollment teams and documents needs and organizational priorities
- 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
- Develops relationships with clients and provides regular status updates on credentialing related deliverables
- 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
- Holds monthly (or as warranted) meetings with all levels of management to review held claims, status of client provider enrollment, overall provider enrollment inventory, etc.
- Monitors timeliness and effectiveness of department activities, implements processes to identify gaps
- Compiles and prepares a variety of reports for management in order to analyze trends and make recommendations
- Performs special projects and other duties as assigned
Education and Experience Requirements- High School diploma or equivalent
- Bachelor's Degree in Healthcare Administration, Business Administration, Benefits, or equivalent training and/or experience preferred
- At least five (5) years of physician billing, hospital billing, or vendor management experience in provider enrollment functions
- At least two (2) years of supervisory/management/leadership experience preferred
- Experience with CAQH database, NPI website and maintaining EDI, EFT, and ERA processes preferred
Knowledge, Skills, and Abilities- Knowledge of provider enrollment requirements for physician billing and multi-state experience preferred
- Knowledge of business and financial processes, procedures, and processes
- Knowledge of medical terminology and anatomy
- Knowledge of requirements of medical record documentation
- Strong supervisory/management skills
- Strong leadership development and team building skills
- Strong management level oral, written, and interpersonal communication skills
- Strong financial reporting skills
- Strong healthcare data analysis skills
- Strong presentation development and delivery skills
- Strong word processing, spreadsheet, database, and presentation software skills
- Strong decision-making skills
- Strong problem-solving skills
- Strong organizational skills
- Strong time management skills
- Strong mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; computing percentages, areas, and volumes; and working with decimals
- Ability to effectively present information, including financial reporting and healthcare analytics, and respond to questions from groups of executives, managers, clients, and customers
- Ability to adapt communication style to suit different audiences
- Ability to communicate with business stakeholders and IT staff in a tactful, mature, and professional manner
- Ability to know how and when to involve key players and effectively use internal employer resources to provide the best solution
- Ability to initiate and maintain professional relationships.
- Ability to see reoccurring issues and fixing them or identify and solve front end issues Ability to communicate with diverse personalities in a tactful, mature, and professional manner
Compensation- Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.
- This position is also eligible for a discretionary incentive bonus in accordance with company policies.
