Job Summary

The Provider Enrollment Supervisor is responsible for providing supervision and structure for the department’s daily operations and functions. The supervisor works to ensure department productivity and quality standards are met or exceeded by coordinating staff and developing efficient workflows. The supervisor guides the staff in their day-to-day responsibilities, including mentoring and training the staff as needed. Must be proficient in facilitation and interpersonal communication, demonstrating skills in organization, prioritization, professionalism and coaching others. This position works with and supports Managed Care, Revenue Cycle, Finance, Treasury and both internal and external customers in various regions to execute tasks related to new payer enrollments. The Supervisor is a representative of the Provider Enrollment Dept and supports internal business partners in all aspects of initial credentialing and re-credentialing of ASCs with various Payor Plans, Government Agencies and State Agencies. Processes and monitors initial and renewal applications for ASCs/facilities. Communicates with ASCs, Contract Managers and Regional Directors regarding payer application processing, the collection of all required documentation; submission to payers and distributes approval documentation. Maintains accurate, organized, and current files and databases; documents all work efforts in department’s task workflow system; assists when needed in audits performed by regulatory and accrediting agencies, Department of Health, managed care organizations/payers, and others; and functions as managed care liaison, advisor and resource person for ASC administrators, business office staff, and other leadership personnel. 

Duties and Responsibilities

• Process initial and re-credentialing ASC payer applications for Government (Medicare/ Medicaid), Commercial and Medicaid/Medicare replacement payers

• Correspond with ASC administrators, business office teams and contract team (Contract Managers and Regional Directors of Managed Care) regarding credentialing needs, status of provider files, or any other questions that arise. Notifies teams when actions are completed.

 • Lead provider credentialing and provider enrollment efforts.

 • Monitor department metrics

• Train staff and create new training documents

 • Identify and communicate trends and resolutions

• Assist in guiding workflow assignments

• Manage projects to ensure deadlines are met

• Support providers, offices, and other shared services with enrollment needs

• Develop and maintain positive working relationships with team members and payer representatives

• Credential providers to be in network with insurance plans

• Organize provider information for multiple practices

• Communicate closely with providers and offices regarding credentialing

• Oversee and facilitate follow up with insurance companies regarding network status on an as needed basis

• Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements

• Attend collaborative meetings • Partner with staff to resolve any challenges they are having

• Adheres to all safety policies and procedures in performing job duties and responsibilities while supporting a culture of high quality and great customer service.

• Performs other duties that may be necessary or in the best interest of the organization

Education: 

4 Year BA Degree or 4 Years of Equivalent Experience 

HS Diploma

Experience Requirements 

• 3+ years of experience in managed care environment (with either payer or provider)

• Experience in the completion of payer facility credentialing applications and an understanding of required facility credentials/licenses strongly preferred 

Knowledge, Skills and Abilities Requirements

• Detailed understanding of Medicare, Medicaid, and Managed Care Plan payors, products, and regulations

• Knowledge of CMS I&A, NPPES & the ability to update as necessary

• Knowledge of Revenue Cycle operations as it applies to investigating & resolving denials when related to Provider Enrollment 

 • Ability to perform essential job function with high degree of independence, flexibility, and creative problem-solving techniques

• Must be able to work under pressure and meet deadlines, while maintaining a positive attitude and providing exemplary customer service

• Goal Driven with a firm understanding of credentialing department KPIs.

• Detail oriented, professional attitude, reliable

• Management and organizational skills to support the leadership of this function

• Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations

• Interpersonal skills to support customer service, functional, and teammate support needs

  Able to communicate effectively in English, both verbally and in writing

• Ability for intermediate problem solving, including mathematics

• Intermediate to Advanced computer operation

 Proficiency with Microsoft Excel, Word, PowerPoint and Outlook

• Specialty knowledge of systems relating to job function

 Payor Portal platforms (PECOS, Availity, State Medicaid)

 Credentialing platforms, related software, and websites (NPPES, CAQH, etc.)

 Adobe Pro (Editor applications)

• Knowledge of state and federal regulations for this position; functional understanding of HIPAA guidelines

Supervisory Responsibilities:

• Directly supervises team members within the Doctor Services function.

• Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.

• Responsibilities include interviewing, hiring, and training employees, planning, assigning, and directing work; appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems

Physical Requirements:

• While performing the duties of this job, the employee is regularly required to talk and hear. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee must frequently lift and/or move up to 10 pounds.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

 

If you need assistance with this application, please contact (636) 227-2600

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

 

Please do not contact the office directly – only resumes submitted through this website will be considered.

 

 

NOTE:  Job descriptions are intended to be accurate reflections of those principal job elements essential for making fair pay decisions about jobs. Nothing in this job description restricts management right to assign or reassign duties and responsibilities to this job at any time.