Responsible for managing all aspects of the provider enrollment & credentialing department, including but not limited to; enrollment applications completion, medical staff credentialing & privileging, work flow, staffing, outsource work coordination. Serve as the internal point person on enrollment and credentialing issues. Provide Practice Solutions Managers (PSM), Operations Managers and management with regular communications regarding the status of all aspects of enrollment and credentialing work. Ensure that all client credentialing and provider enrollment processes (individual doctors and physician groups) are completed in an accurate, timely manner and all existing group/physician credentials are up to date. Duties are somewhat broad in nature, often requiring originality and ingenuity.

RESPONSIBILITIES:

• Demonstrate leadership.
• Monitor progress made on all enrollment accounts.
• Answer staff and management questions in a timely and productive manner.
• Establish procedure/training for individual staff members or entire departments.
• Complete enrollment packets and medical staff credentialing packets for providers and groups in an accurate and timely manner. This may include, but is not limited to; follow up phone calls, emails, faxing information, sending letters, etc. to secure the needed information.
• Work closely with the group/physician to ensure proper and timely staff re-credentialing & privileging results.
• Monitor department activities to assure all tasks, phone calls, emails and other forms of communications are documented.
• Assure that all client professional information is scanned and entered into credentialing systems.
• Maintain provider records and files with accuracy.
• Utilize tools and resources to ensure the credentialing and enrollment processes are efficient and accurate.
• Develop additional training in SyMed/Echo OneApp Pro to expand the capabilities of the software for the department.
• Serve as the liaison between providers and carriers to ensure all parties have submitted the appropriate information and are processing the information within an acceptable time frame.
• Resolve issues concerning credentialing and enrollments with carriers.
• Establish and maintain a network of key contacts from provider reps to senior level network management with various carriers to expedite and encourage credentialing and contract execution.
• Assure that the department tracks and follow-ups on provider documents that are set to expire and notify clients of upcoming due dates.
• Handle all re-credentialing requests from carriers.
• Coordinate and oversee the work flow, which includes making sure there is adequate staffing and work for the existing staff at all times.
• Delegate responsibilities appropriately. Review work of individual employees.
• Direct work assignments, measure results and initiate personnel actions as required.
• Communicate with client by phone or via email and serve as a direct contact with client regarding provider enrollment status/issues/concerns.
• Be available and open to employees for knowledge, support and training.
• Keep PSM informed of direct contact with client on issues/concerns. Follow-up with client when appropriate.
• Coordinate and conduct regular departmental meetings as appropriate.
• Demonstrate initiative in resolving processing problems.
• Other duties as assigned.

      QUALIFICATIONS:

• Strong communication skills; both written and verbal
• Ability to interact professionally and productively with all levels of the organization and our clients
• A ‘do what it takes” attitude, strong team focus, and a demonstrated ability to lead by example
• Ability to organize and set work priorities, work under pressure and meet deadlines
• Ability to effectively manage staff
• 3 to 5 years health care credentialing and enrollment experience
• Skill in establishing, monitoring and maintaining a system of records, software programs, databases and reports
• Strong PC skills, with intermediate to advanced knowledge of MS Word and Excel and contact management systems
• College graduate preferred
• Ability to maintain strict confidentiality and follow government confidentiality regulations
• Demonstrates a professional demeanor