Inspire health. Serve with compassion. Be the difference.

Job Summary

Responsible for planning, organizing, and leading functions of enrollment for Managed Care credentialing and facility credentialing. Leads team that completes complex facility applications and issue resolution. Works with Operational Leaders and Revenue Cycle Leaders to identify, recommend, develop, implement and support process improvement. Oversees Echo Credentialing database and ensures team is adhering to standards set forth and staying in compliance with NCQA guidelines and payor contracts.

This is a remote position.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose:  Inspire health.  Serve with compassion.  Be the difference.
• Oversees and/or maintains Epic Database, Payor Enrollment and Epic Billing system credentialing edits/denial work ques. Manages applications ensuring issues are triaged and resolved in a timely fashion.
• Responsible for all aspects of training, Epic Work ques, Managed Care Credentialing, Rosters, Echo, Workflows and other internal processes.  Maintains materials in our One Note Provider Enrollment Manual. Monitors volumes in work ques and reassign duties
• Assists in leading and providing oversight in operational services associated with revenue cycle including Changes of Ownership and Name Changes to insure successful claims adjudication.  Oversees the development of tracking tools to analyze data to identify claim trends to ensure responsible decision making. Oversees claim hold work ques to ensure claims are moving out successfully.
• Manages the development and implementation of policies and procedures to ensure effective operations. Directs the development of standards of performance and mechanisms for problem resolution.  Responsible for compliancy with governmental payor standards and NCQA standards.
• Plans, supports, and coordinates activities to ensure that goals and objectives of project are accomplished within prescribed time frame and funding parameters. Reviews project proposal or plan to determine time frame, funding limitations, procedures for accomplishing project, staffing requirements, and allotment of available resources.
• Recruits and hires departmental staff members. Develops a departmental staff training program to ensure all employees understand departmental and System policies and procedures. Research current education and training needs, monthly rounding.
• Establishes sound working relationships and cooperative arrangements with Revenue Cycle, MSO and CVO departments and executives. Leads and oversees Physician/Provider onboarding and special programs.
• Serves as the Authorized Official within the Governmental Identity and Access System. Assigns surrogate privileges to appropriate Prisma Health employees. Serves as Delegated Official on behalf of Prisma Health within the Governmental Medicare and Medicaid System. Signs on behalf of System along with CEO, CFO, COO and Executive Director of Revenue Cycle.
• Serves as an enrollment subject matter expert for all functions including managed care credentialing, facility credentialing and credentialing Epic work ques. Serve an active role in planning successful implementation of programs. Called upon to participate in meetings to advise about proper procedures and processes required in order to acquire revenue for services rendered by System facilities and providers. Leads team to successfully leading monthly enrollment calls with our payors to resolve outstanding issues and confirm provider/locations loaded at payor.
• Conducts weekly audits on provider enrollments including locations reviewing information in Echo compared to analysts' applications, ensuring accuracy prior to submission.  Also, includes facility credentialing applications.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• Job has direct and/or indirect supervision of team members that may include final budget authority, hire/termination authority, performance appraisal responsibility and disciplinary authority. Job will be considered a member of management staff at Prisma Health or affiliate and will have direct reports.

Minimum Requirements

• Education - Bachelor's degree in Business or Health Care Administration
• Experience - Five (5) years of Healthcare, Revenue Cycle, Enrollment, Payor Experience. Two (2) years supervisory/management experience. Governmental enrollment experience. Revenue cycle experience preferred

In Lieu Of

• In lieu of a Bachelor’s degree, nine years of Healthcare, Revenue Cycle, Enrollment, or Payor experience may be considered,
• In lieu of a Bachelor’s degree, five years of work experience including four years supervisory/management experience may be considered.
• In lieu of a Bachelor’s degree, and equivalent combination of work/academic experience may be accepted.

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• Knowledge of office equipment (fax/copier)
• Proficient computer skills (word processing, spreadsheets, database)
• Data entry skills
• Mathematical skills
• Epic follow-up and claim edit work ques skills - preferred

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

Corporate

Department

Provider Enrollment

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.