Operations Supervisor - Provider Enrollment

Job Purpose

The Operations Supervisor, Provider Enrollment is responsible for the supervision and oversight of global staff and policies & procedures, and working closely with the Manager, Provider Enrollment to ensure the credentialing/enrolling of new and established health care providers and other policies/procedures of the department are being followed.

Duties & Responsibilities

• Oversee issue resolution for the provider education process regarding application completion and submission
• Oversee and ensure that the collection, updating and maintenance of necessary provider information and documentation is completed
• Oversee and ensure that the enrollment follow-up, by client and payer, is completed within departmental and client parameters
• Ensure that provider enrollment applications for all initial applications and re-credentialing are completed in a timely and complete manner
• Ensure verification of provider and group information with insurance companies is completed
• Ensure that the information for enrollment and termination of all providers is accurate and communicate to team and clients as appropriate.
• Implement and maintain client and Company Q/A standards and protocols and coordinate with department manager quarterly reporting of same
• Act as the point of contact to the client to troubleshoot any issues and escalate as needed to management
• Contribute to the departmental process and procedures with a collaborative approach
• Monitor mPower and other provider reports to ensure they are kept current and report any deficiencies in same
• Assist in the training and education on enrollment processes or required research for accuracy, ensuring that all training activities are complete and up to date
• Document and record training sessions to be used for future reference
• Monitor and analyze productivity along with performing Q/A for all staff
• Provide timely feedback to offshore provider enrollment regarding Q/A process and results
• Identify struggles with Provider Enrollment staff and provide guidance when needed globally
• Performs other duties as requested
• Use, protect and disclose patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
  
  

Qualifications

• At least 1 year of solid Provider Enrollment experience
• High school diploma or equivalent required
• Knowledge of and experience in healthcare billing preferred
• Experience with CAQH required
• Microsoft Office Suite knowledge/use required
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction
  
  

Working Conditions

• Work Set-Up: Onsite
• Work Schedule: Night shift, US hours
• Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.
  
  

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.