Healthcare Provider Enrollment/Credentialing Manager

Description:

As a member of the MMG RCM Leadership Team will develop, manage, and monitor processes and procedures that support client provider payor enrollment/expirable data management.  Oversee all payer enrollment functions including application management, primary source verification, and administrative oversight of staff. Ensure compliance and appropriate client provider accrediting with payors and regulatory agencies. Supervise assigned RCM staff and oversee day-to-day execution and delivery of service to portfolio of revenue cycle clients including talent acquisition and development, problem solving, and ongoing client interaction and communication.  

Responsibilities:

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• Manage a team of Provider Enrollment Specialists, collaborate with the management team, and support department in day-to-day business execution while providing extraordinary customer service.
• Function as coach, leader, catalyst, and facilitator with team members. 
• Promote growth and uphold accountability with team through established developmental goals, competencies, guidance, and counseling.
• Provide direction to team members and organize the provider enrollment functions to maximize departmental productivity.
• Serves as an expert and point of reference for all processes and workflows. 
• Conduct regular audits of all work of assigned team.
• Review, revise, and administer processes and procedures to increase operational efficiencies.
• Implement new systems as needed with focus on continuous improvement.
• Adhere to all MMG and client policies and processes.
• Conduct meetings both internally and with existing clients to include preparing agendas and providing post-meeting minutes.
• Monitor and report turnaround times for processing of enrollment applications, with continued focus on delivery of high-quality products with the greatest efficiency. 
• Develop and prepare reports monthly/quarterly to summarize department activity and status. 
• Conduct trainings with department members on all aspects of the provider enrollment process including but not limited to:

      - Contract specifics

      - CAQH creation, completion, and re-attestation

      - Adding new providers to existing practices

      - Demographic changes

      - Contracting-adding providers to new insurances

      - Policies and Procedures

      - Industry or regulatory compliance changes

• Manage new practice set up and onboarding (i.e. gathering information, insurance discovery, setting up the client folder and spreadsheets)
• Manage client contracts for both new and existing clients and ensure team has clear understanding of contract details or work to be performed. 
• Work with managers and clients on set up for new tax-ids.
• Maintain and ensure compliance with regulatory standards.
• Build strong working relationships with medical facilities, provider offices, and Health Plan Representatives.
• Provide concise, timely communication to appropriate leadership regarding potential enrollment issues.
• Work with physicians, professional staff, and physicians' office staff to acquire necessary materials and information.
• Participate in seminars or conferences as required.
• Other functionally related duties as assigned.

Qualifications:

• High school diploma or equivalent required. Associates or Bachelors degree desired.
• Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) viewed favorably.
• 5+ years credentialing/revenue cycle experience is required with at least 5+ years in a supervisory or management capacity with provider credentialing.
• Proven ability to train, lead, mentor, and develop subordinates.
• Knowledge in reimbursements.
• Proficiency in specialties and ancillary services is required. 
• Prior exposure to setting up EFT processes for Medicare, Durable Medical Equipment and Department of Labor.
• Understanding startup up process and onboarding a new or established provider enrollment engagement.
• Ability to organize and prioritize responsibilities while remaining flexible to changing demands.
• Ability to react calmly and effectively in high stress or delicate situations.
• Excellent written and oral communication skills, people skills, and an ethical mindset. 
• Able to analyze complex data and draw conclusions.
• Must have a high level of discretion and judgment with the ability to make decisions.
• High proficiency with computer software including but not limited to insurance websites, Microsoft Office products (Word, Outlook, Teams), and developing excel and PDF files.
• Experience with billing platforms required and proficiency in utilization of payor enrollment platforms viewed favorably.
• Ability to maintain working relationships with the provider, management team and staff. 
• Work in collaboration with other staff to promote and maintain a team-oriented environment. 
• Ability to research, stay up to date, and educate others on specific rules and guidelines for enrollment and credentialing requirements for Ohio and other states.

Physical Demands

• Travel to MMG and client meetings as required.
• Work may require sitting for extended periods of time. 
• Operating a computer, keyboard, telephone, copier, fax, scanner, or other such office equipment through a normal business day. 
• Vision must be correctable to 20/20 for viewing information on computer screen and reading information in a paper format. 
• Hearing must be in the normal range for telephone contacts.
• Will require viewing computer screens and typing on a keyboard for prolonged periods of time.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

This job description is intended to provide a basic guideline for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change, as necessary.