Under the direction of the Executive Director of Centralized Credentialing, the Director of Provider Enrollment will be responsible for developing, organizing, implementing and managing projects assigned to enhance productivity and reduce or redirect expenditures for the Johns Hopkins University Clinical Practice Association (CPA), Johns Hopkins Physical Medicine and Rehabilitation, Johns Hopkins Regional Physicians, and Johns Hopkins Community Physicians. This position will develop and maintain efficient workflows with the clinical departments, Medical Staff Offices, providers and payers for timely enrollments. Duties include developing and writing policies and procedures for related units of responsibility and providing management oversight for the Provider Enrollment Department.
Essential Functions- Retain a comprehensive knowledge of the complex insurance regulations, laws and contracts affecting the revenue operations of the Clinical Practice Association as it relates to provider enrollment activities.
- Establish and maintain a working relationship with insurers and implement enrollment policies and procedures to ensure JHUSOM, JHRP, JHCP, JHH Physical Medicine and Rehabilitation are aligned with access to care and provider reimbursement.
- Prepare workflow and efficiency recommendations for review by the Senior Director, Professional Billing, clinical department administrators and entities, and Executive Director Centralized Credentialing Office.
- Develops meaningful oversight reports and tools to illustrate payer enrollment performances, maintain unit productivity.
- Proactively research, interpret, and communicate complex provider enrollment guidelines and specifications that impact accurate claims submission, payments, and appeals that affect PBS operations and the filing and reimbursement of claims for numerous Production Billing Unit Specialties.
- Monitor billing, referring and ordering, and prescribing provider enrollment time-lines, edit resolutions, and enrollment team productivity.
- Represents the Clinical Practice Association in developing relationships with Production Unit Managers, Administrators, and other credentialing and external units to expedite and improve enrollment information accuracy.
- Facilitate PECOS/E-Prep processes and approvals.
- Continually look for process improvements and target problem areas and identify what needs to occur to ensure staff works effectively as a team and errors are minimized.
- Continue to update and develop billing policies, instructions, and job-aides for increased team member understanding, compliance, and ease of use.
- Establish procedures, measures and reporting tools to enhance standards and productivity within credentialing database.
- Monitor staff performance in credentialing database via creation of KPIs and reports.
EducationBachelor's degree in healthcare or business-related field required. Master's degree highly preferred.
Knowledge, Skills, and Abilities:• Recent experience and subject matter expertise with Medicare, Medicaid, and commercial payer regulations required.
• Knowledge and expertise with EPIC PB Resolute required.
• Comprehensive knowledge of and compliance with HIPAA rules and regulations regarding the dissemination of patient Protected Health Information (PHI).
• Thorough understanding of clinical practice management, medical billing, and the unique customer service requirements related to patients, physicians, and administrative staff in a high-volume medical services environment.
• Detailed knowledge of payer and government enrollment policies, credentialing, and medical staff privileges that affect billing and revenue cycle operations.
• Excellent communication and customer service skills, with the ability to work well under pressure.
• Knowledge of federal and state government, and commercial enrollment regulations.
• Comprehensive knowledge of complex insurance regulations and laws for facility and physician billing.
• Strong interpersonal skills, including negotiation, analytical, written and oral communication skills, and the ability to work collaboratively.
• Strong PC, analytical, and coding skills.
• Ability to exercise a high degree of initiative, judgment, discretion, and decision-making to achieve organizational objectives.
• Strong organizational skills and the ability to meet deadlines and work well under pressure.
• Ability to operate basic office equipment, such as a photocopier, fax machine, scanner, PC, and telephone.
Required Licensure, Certification, On-Going TrainingSeven years of progressive responsibility and related experience and knowledge of federal and state government and third-party regulations including five years of relevant supervisory/managerial experience.
What We Offer:You can become a part of our diverse healthcare leadership team and enjoy extensive benefits with a variety of opportunities for personal and professional growth. From academic medical centers to local community hospitals, from downtown to the suburbs, Johns Hopkins Medicine has a work environment that will fit your personality and career goals.
Comprehensive benefits including medical, dental, and vision insurance; generous paid time off; life and long-term disability coverage; 403(b) retirement plan with employer match; tuition assistance for employees and dependents; and wellness programs just to name a few.
Salary Range: Minimum 103,605.00/annually - Maximum 161,907.00/annually. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
The Hospital reserves the right to modify employee schedules as needed.
