Supervisor Payor Enrollment

Saint Luke's Health System•Kansas City, MO

About The Position

Payor Enrollment is responsible for creating and maintaining provider records in payor enrollment software, providing support and training to other personnel using payor enrollment software, completing online state provider enrollment applications (CAQH) for all providers, maintaining the CAQH attestation every 120 days, completing all provider specific documents for enrollment, promptly submitting practice and provider changes to the appropriate parties upon receipt, assisting with non-participation issues, maintaining the team email for enrollment correspondence, researching new provider specialties with payors to establish enrollment and maintains provider’s enrollment status by coordinating revalidations for payors ever 2-3 years as required by manage care and government companies. This position also works on payor enrollment claim denials, maintains accuracy on the claims and the system(s) for group, practice and provider information. This position requires an ability to correspond in a professional manner with providers to obtain confidential passwords, gaps in history, malpractice details, etc. The Supervisor is responsible for the ongoing daily operations of Payor Enrollment. This position assists the manager in providing support, feedback and direction to staff and is responsible for the management and analysis of initiatives, teams and functions. This includes but is not limited to, data extraction, analysis and monitoring tools. The Supervisor works collaboratively with leadership to assist in development, project management and implementation of process enhancements or corporation initiatives to enhance the payor enrollment process. The Supervisor is responsible to be a subject matter expert in the assigned area. Evaluates effectiveness of processes and makes process improvements. Ensures processing work to the highest quality standards and ethics while maximizing revenue. The Supervisor is responsible to ensure successful outcomes by training, leading, inspiring, coaching, mentoring and motivating all staff. Is responsible to ensure goals and initiatives are being met and on time. Schedules and leads meetings with providers, peers, staff, payors and vendors. Establishes written process documents. Analyzes and monitors data to drive continuous improvements in the revenue cycle. Assists in monitoring quality assurance programs, this position fosters the integration of the organizations vision and values and accomplishes the mission and strategic plan through an accountable work team. Must have Payor Enrollment Specialist certification or obtain it it within 6 months of hire.

Requirements

3-5 years Provider Enrollment Specialist
Decision Health Associate Degree
Must have Payor Enrollment Specialist certification or obtain it it within 6 months of hire

Responsibilities

Creating and maintaining provider records in payor enrollment software
Providing support and training to other personnel using payor enrollment software
Completing online state provider enrollment applications (CAQH) for all providers
Maintaining the CAQH attestation every 120 days
Completing all provider specific documents for enrollment
Promptly submitting practice and provider changes to the appropriate parties upon receipt
Assisting with non-participation issues
Maintaining the team email for enrollment correspondence
Researching new provider specialties with payors to establish enrollment
Maintaining provider’s enrollment status by coordinating revalidations for payors ever 2-3 years as required by manage care and government companies
Working on payor enrollment claim denials
Maintaining accuracy on the claims and the system(s) for group, practice and provider information
Assisting the manager in providing support, feedback and direction to staff
Responsible for the management and analysis of initiatives, teams and functions
Working collaboratively with leadership to assist in development, project management and implementation of process enhancements or corporation initiatives to enhance the payor enrollment process
Evaluating effectiveness of processes and makes process improvements
Ensuring processing work to the highest quality standards and ethics while maximizing revenue
Ensuring successful outcomes by training, leading, inspiring, coaching, mentoring and motivating all staff
Ensuring goals and initiatives are being met and on time
Scheduling and leading meetings with providers, peers, staff, payors and vendors
Establishing written process documents
Analyzing and monitoring data to drive continuous improvements in the revenue cycle
Assisting in monitoring quality assurance programs
Fostering the integration of the organizations vision and values and accomplishes the mission and strategic plan through an accountable work team