Provider Enrollment & Onboarding Manager

The Stamford Hospital•Stamford, CT

55d•Remote

About The Position

Reporting to the Executive Director, Revenue Cycle, this position manages all aspects of the credentialing and enrollment process with governmental and other third-party payers for employed and/or contracted physicians and mid-level providers of Stamford Health System, and serves as the project manager for onboarding and offboarding SHMG providers. The Manager supervises and oversees performance of credentialing and enrollment staff ensuring timely, accurate and compliant processes to maximize reimbursement from all carriers. As Manager of information related to new provider hires will work with various departments to coordinate the onboarding of SHMG providers into the organization. The Manager will plan and provide for efficient staffing levels, policy and procedure development and education for direct reports and other practice staff as needed related to the enrollment and provider onboarding process.

Requirements

Bachelor's Degree and five years of professionally related experience in a physician practice setting.
Minimum of three years in a supervisory role with demonstrated ability to provide employee performance and skill development feedback and guidance including performance evaluations, mentoring and performance improvement plans up to and including termination.
Strong problem-solving skills and ability to make timely decisions in a fast-paced environment.
Demonstrated ability to work in a continuously changing environment and willingness to assist with a variety of tasks as needed.
Willingness to learn and share knowledge with others.
Willingness and ability to empower, delegate and monitor staff performance, encourage the development of innovative and effective solutions by staff and facilitate those solutions through implementation.
High level of competency with computers, the Internet, and computer software such as MS Office or equivalent is required.
A thorough understanding of regulatory requirements pertaining to health care operations and their impact on third party payer participation.
Ability to work, plan, research and conduct projects with minimal supervision.
Ability to organize and prioritize workload to manage multiple tasks and meet deadlines.
Superior verbal, written, organizational, and interpersonal skills are required. Effectively communicates with internal and external customers positively and professionally.
Ability to work with individuals at all organizational levels, particularly peers, team members, other departments, patients, and the community is required.
This is a remote position but candidate would be required to live or relocate to live in the Tri-state area, Connecticut, New York or New Jersey.

Responsibilities

Responsible for the supervision of credentialing and enrollment staff including recruiting, training, evaluating and monitoring quality of work and productivity of the department. Establishes work schedules and ensures appropriate resources to complete work within established guidelines. Verifies and approves weekly payroll. Monitors and reviews hours worked for supervised staff as well as overall attendance patterns to ensure adequate staffing to meet departmental requirements.
Develops and implements communication strategy to accurately update and maintain all internal systems and resources with appropriate provider and network participation information. Communicates provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for professional services rendered.
Provides for the development and maintenance of detailed provider credential and enrollment files in appropriate format.
Accurately completes or provides for the completion of the enrollment/reenrollment processes as outlined by each payer for all appropriate healthcare providers to ensure timely and continued provider network participation. Performs as necessary the functions of the department to ensure productivity levels are met.
Manages group level credentialing, contracting and enrollment processes with third party and governmental payers e.g. reporting of group practice changes to Medicare via 855B updates, Medicaid re-enrollments, working with new payer contracts to enroll group/providers.
Chairs regular meetings of the Project Planning Committee. Prepares and distributes project plans for onboarding and offboarding of SHMG providers as well as office moves/closures.
Troubleshoots concerns throughout the onboarding process and works with multi-disciplinary practice personnel to find appropriate solutions to ensure timely completion of tasks.
Works closely with internal constituents and Senior Leadership to continually develop the onboarding program and assess for effectiveness.
Responsible for maintenance of the Billing Provider and Referring Provider Dictionaries in eCW.
Responsible for maintenance of the Facility Dictionary in eCW.
Responsible for administering an effective performance management program ensuring that departmental job descriptions are reflective of current responsibilities, defining and administering a career progression for staff seeking advancement, ensuring that performance management tools (e.g. metrics, review templates) are reflective of current responsibilities and performance standards, clearly communicating performance expectations to staff, completing and administering meaningful performance reviews on time, and issuing and monitoring corrective performance management plan as is appropriate and indicated up to and including termination for continued non-performance.
Develops and maintains a schedule/program for quality review to be completed in a timely and routine manner. Conducts audits and work product reviews in accordance with established plan. Compiles results and prepares reports for appropriate personnel.
Assures that supervised staff orientation is provided based on job requirements, initially and ongoing as needed. Ensures that supervised staff has completed annual mandatory education as required. Conducts competency testing as needed.
Assists Executive Director and other practice leadership in the research, development, implementation, maintenance of and compliance with practice policies, procedures, and guidelines related to third party enrollment, provider licensure and credentials, compliance and the overall revenue cycle.
Assures employees are familiar with, have access to, and comply with polices, procedures, reference materials which conform to current regulatory requirements. Arranges for staff to attend internal and external education as needed.
Assists in conducting departmental meetings and communicates changes in policies, procedures and general tasks to supervised and other practice staff. Participates on and provides committee support as needed. Leads or participates in cross-functional project teams when asked or indicated.
Analyzes data, identifies issues, reaches conclusions, and propose strategies for resolution of complex reimbursement issue as they relate to credentialing and participation status. Works with other departmental managers and staff as needed to develop appeals to insurance carriers for participation denials.
Keeps informed regarding current regulations, insurance company policies, professional standards and company/department policies and procedures and effectively applies this knowledge.
Demonstrates flexibility to revise priorities in order to assist others within Stamford Health System to the benefit and the improvement of the organization.
Other duties as assigned by manager.