Supervisor: Provider Relations, Enrollment & Delegated Credentialing

HHC•Indianapolis, IN

About The Position

The Supervisor provides leadership and operational oversight, of Provider Relations, Enrollment, and Delegated Credentialing functions supporting enrollment of over 540 providers at more than 40 locations with all contracted governmental and commercial insurance plans in order to ensure reimbursement of services rendered at all locations for all providers for whom Eskenazi is responsible for billing. Eskenazi contracts with more than 16 payors and continues to increase that number. The Supervisor is responsible for rounding with team members to assist with workflow, productivity, training, quality reviews as well completing and delivering annual performance appraisals and updating Kronos. This position is responsible for ensuring accurate, timely completion of all functions including delegated credentialing, provider enrollment, and provider relations for all payors with whom we are contracted. This position is responsible for ensuring compliance with payor contract requirements and guidelines, including Medicaid, Medicare, Managed Care and Commercial Payors as well as NCQA and others as pertinent to the areas of responsibility. The position is responsible for ensuring adherence to all requirements through development of workflow, policies and procedures, audits (internal/external) and staff development and education in collaboration with or at the direction of the Manager. This position is responsible for working closely with the Director, Managed & Value Based Care to ensure that all locations and providers are appropriately contracted to ensure compliance with designated requirements and reimbursement of services rendered at all locations. This position is also responsible for completion of all related functions (Enrollment, Delegated Credentialing and Provider Relations) within the department as directed by the Manager to support operational needs.

Requirements

Associate’s required or Bachelor’s degree preferred.
5+ years of experience in enrollment, delegated credentialing and provider relations will be considered in lieu of degree.
Must have experience completing enrollments for facility and providers with Medicare and Medicaid
Must have experience with delegated credentialing including knowledge of NCQA guidelines and audit protocols and contract requirements
Requires excellent communication skills (written, oral & presentation), interpersonal skills, a high level of organization and the ability to mentor others
Must have knowledge of NCQA guidelines for initial and re-credentialing
Must have knowledge of Medicare and Medicaid and other payor guidelines and requirements specific to provider and facility enrollment and delegated credentialing.
Must be attentive to details and ability to follow complex procedures
Ability to motivate staff in achieving departmental goals while maintaining positive internal and external customer relationships
Communicate effectively with wide variety of staff in including peers, operational leaders, providers (physicians, mid-level licensed staff, & Advanced Practice Professionals)
Manage conflict and negotiate effectively with individuals and groups
Ability to work independently and exercise professional judgment to meet daily operational demands
Ability to work effectively under pressure and accept responsibility for decisions
Experience working in Microsoft Office suite applications including Excel, Word, and Power Point

Nice To Haves

Experience with Provider Relations Functions (Panel management, Payor meetings, etc) desired
CACTUS and EPIC experience a plus.

Responsibilities

Responsible for assigning and monitoring workflow to ensure accuracy and timeliness for all functions within area of responsibility including (but not limited to) delegated credentialing, provider enrollment and other areas/tasks as requested by Manager to ensure appropriate reimbursement of services rendered.
Responsible for daily supervision, training and quality reviews for all team members within area of responsibility.
Responsible for approving PTO requests and updating Kronos as well as completion of performance evaluations with team members.
Responsible for ensuring ongoing audit of internal processes, payor rosters, and directory validations are completed monthly to ensure compliance with Federal Regulations governing Directory Validations, Interoperability, Surprise Billing regulations, and other regulations as required.
Responsible for creating KPI’s (productivity standards) for all team members and completing audits at least quarterly. This includes creation of audit tools, documentation of results and providing feedback to team members and status reports to Manager.
Leads and attends meetings in the absence of the Manager including staff meetings and meetings with external partners within and outside of Eskenazi Health. This may include ongoing committees such as Delegated Credentialing and Provider Relations Committees among others.
Create and ensure ongoing maintenance of CACTUS, PECOS, I&A/NPPES, CAQH Proview and other databases critical to the credentialing and enrollment functions. This includes:
Coordination with other departments (operational and EPIC) to ensure timely notification of new providers, terminating providers and provider updates.
Ensures that supporting documentation is retained in CACTUS and Provider Enrollment files.
Responsible for maintaining ongoing, current knowledge of all Federal and State Laws and regulations, payor regulations, NCQA, contractual requirements, and other industry standards and communicates changes and updates to team members and leadership to ensure ongoing compliance of existing work-flows.
Provides ongoing support to the team including assistance with completion of various functions as needed to support the operational needs for all functions within area of responsibility (ie. Provider and facility enrollments, delegated credentialing, and provider relations functions).
Assists Manager with budget maintenance and explanation of variances.
Serves as a primary resource and liaison to Revenue Cycle stakeholders, internal and external partners in identifying and addressing operational improvement opportunities related to delegated credentialing, enrollment and related areas to ensure appropriate reimbursement of claims for services provided.
Responsible for monitoring EPIC WQs related to area of responsibility to ensure timely review of claims and identification of issue/solution to ensure appropriate reimbursement and reduce denials related to these areas of responsibility.