Manager, Provider Enrollment

Role Overview

• Manages Provider Enrollment Department operations; recruits, selects, orients, trains, coaches, counsels, and disciplines staff.
• Plans, monitors, appraises, and reviews staff job contributions.
• Implements cross functional training and succession planning as allowable.
• Develops relationship with clients and provides regular status updates on the credentialing process on a regular basis.
• Coordinates with client leadership and credentialing staff as necessary to obtain documents and additional information necessary to complete enrollment process.
• Holds monthly (or as warranted) meetings with all levels of management to review held claims and address concerns.
• Reports major issues to MGA leadership and makes aware of potential threats/opportunities.
• Develops policies, guidelines, and implements procedures and ensures consistent department-wide implementation.
• Enhances and standardizes work-flow processes throughout the enrollment cycle to assist in achieving consistency and success.
• Monitors timeliness and effectiveness of department activities.
• Compiles and prepares a variety of reports for management in order to analyze trends and make recommendations.
• Conducts regular meetings with the team and provides suggestions for improvement and decision support
• Protects and safeguards company and patient information and reports suspicious activity to management.
• Performs special projects and other duties as assigned.

Requirements

• High School diploma or equivalent
• Bachelor's Degree in Healthcare Administration, Business Administration, Benefits, or equivalent training and/or experience preferred
• At least two (2) years of physician billing, hospital billing, or vendor management experience in provider enrollment functions
• At least one (1) year of supervisory/management/leadership experience preferred
• Experience with CAQH database, NPI website and maintaining EDI, EFT, and ERA processes 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 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.

Benefits

• Ventra performance-based incentive plan
• Referral bonus
• Health insurance
• Retirement plans
• Paid time off