Supervisor, Provider Enrollment

Ventra Health•Dallas, TX

19h

About The Position

The Supervisor, Provider Enrollment is responsible for assisting with the day-to-day activities of the Provider Enrollment Department, acting as the first line leader to staff, and contributing to the development of processes and procedures. This role involves monitoring the quantity and accuracy of activities performed by subordinate staff, developing work plans, and maintaining performance standards associated with various functions. The position requires expert knowledge and independent application of state and federal regulations governing healthcare, along with a high degree of applied knowledge of provider enrollment nuances. Responsibilities include staff training, assisting staff to resolve complex provider enrollment issues, performing deep-dive audits of specific accounts, payers, or work performed by individuals, and drafting processes and procedures consistent with applicable regulations and/or specific payers. The role also involves interpretation of complex regulations and department procedural billing policies, and supervision of subordinate staff.

Requirements

High school diploma or equivalent required
Two (2) years’ experience in supervision.
Two (2) years’ experience in Provider Enrollment.
Knowledge of NCQA standards as it relates to provider enrollment and health plan enrollment.
Excellent verbal and written communication skills.
Proficient in Microsoft Office Suite and proprietary database applications.
Ability to use independent judgment and to manage and impart confidential information.
Ability to multi-task, manage priorities and meet critical deadlines.
Ability to work independently and in a fast-paced environment.
High level of awareness of pertinent details; excellent organizational skills.

Nice To Haves

college degree preferred

Responsibilities

Supervise, train, and support provider enrollment staff responsible for licensing, provider enrollment, privileging, enrollment, reappointments and/or maintenance of professional credentials.
Work with Provider Enrollment Manager to complete employee relation duties as necessary such as coaching, mentoring, corrective action, or similar.
Review, edit, and process employee timecards, and schedules.
Assist with or prepare annual performance reviews for provider enrollment staff.
Send Medicaid Revalidation reminders for all providers.
Monitor held claims in AIMs/Work release emails for held claims.
Conduct client calls to provide status updates on clients.
Work with AR to research provider enrollment related denials.
Work with Clean Claims to research provider enrollment related rejections.
Ensure any questions regarding releases are answered in a timely fashion.
Responsible for ensuring Medicaid provider enrollment items are completed timely.
Work with Client Management to provide support on client concerns and updates.
Enrollment for special projects and provide additional support as needed.
Meet staff for one-on-one touch base on performance/feedback concerns.
Work with Payments for requested EFT enrollments/updates.
Develop, maintain, and track various performance measures.
Prepare status reports and perform special projects as required.
Performs other related job duties as assigned.