Posted on August 29th, 2019
JOB DESCRIPTION OVERVIEW:
The Provider Enrollment Manager has overall responsibility to assists with planning, organizing, and direct provider enrollment activities as assigned by Provider Enrollment Director and Chief Financial Officer.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Ensures that all assigned Billing Groups and Providers are in compliance with rules and regulations regarding the application for, obtaining and system maintenance of provider numbers for various carriers.
- Manages information maintenance of provider numbers, National Provider Identifier (NPI), requirements of third party carriers for provider numbers, and conveys necessary information on a timely basis to the corporate PETF and Billing Center management staff.
- Manages maintenance of physician files in the billing system, specifically additions, deletions, and changes pertaining to physicians and other pertinent information. This includes a monthly review of group memberships.
- Directs the Provider Enrollment Assistant and Provider Enrollment Reps I & II on the proper procedures regarding the conduct of provider enrollment activities, manages day-to-day workflow and productivity.
- Assists with training new staffs, leads, and motivates staff.
- Possesses a thorough understanding of and maintains all aspects of the applications used, including Team Works and IDX AES.
- Interrelates with Recruiters, Credential Coordinators, VP of Physician Services, and VP of Operations to facilitate the provider application process,outstanding billing applications, credentials, and NPI.
- Reports to Provider Enrollment Director and division on issues that can enhance provider enrollment and on problem physicians and carriers.
- Manages Denial Management System (DMS) workflow for the department to ensure Provider Enrollment Reps I & II are completing by the suggested deadline.
- Assists with Supervising the maintenance of source document files for each state in which TeamHealth has contracts or otherwise performs medical billing. The source document file consists of applications utilized in the provider enrollment process.
- Acts as liaison with the Division Physician Services Group and VP of Operations to obtain current information on all new physicians and changes in the group.
- Provides education to the management staff, Medical Director’s, Provider Enrollment Assistant, and Provider Enrollment Representatives I & II pertaining to changes in provider enrollment rules and regulations.
- Manages the overall day-to-day workflow and communicates with the Provider Enrollment Director on issues or obstacles inhibiting performance.
- Produce the Provider Hold Report weekly and distributes to management staff and Billing Centers.
- Produce Outstanding Billing Applications report to identify issues.
- Assists with Measuring Provider Enrollment productivity by meeting with staff monthly to discuss issues.
QUALIFICATIONS / EXPERIENCE:
- Ability to work with a database and optical scanning.
- Effective oral and written communication skills.
- Good decision-making, analytical, managerial, and problem-solving skills.
- Ability to handle to develop a plan of action to handle new contracts.
- Degree in business or management related field, preferred.
- Three years of experience in medical billing with specific experience in provider enrollment, or physician credentialing.
- Training classes, and seminar attendance may require travel.
- Manages Provider Enrollment Assistant and Provider Enrollment Representatives I and II
PHYSICAL / ENVIRONMENTAL DEMANDS:
- General office environment.
- Job performed in a well-lighted, modern office setting;
- Occasional lifting/carrying (10 pounds or less);
- Prolonged sitting; with prolonged work in a computer/PC;
- Occasional work in evenings and on weekends;
- Moderate stress;
- May require moderate overnight travel;
- Overtime may be required and can be mandated by Management.
- Ability to work well in fast-paced environment.
This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.
The above information on this description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.
Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.
APPLICANTS APPLY TO:
Amanda Panell, SHRM-CP
Manager, Human Resources
Southeast and LifePoint Group
1431 Centerpoint Blvd. Suite 100 | Knoxville, TN 37932
work: 865.293.5262 | fax: 865.291.3263 | firstname.lastname@example.org