Supervisor, Provider Enrollment

Beth Israel Lahey Health • Wakefield, MA

2d • $67,995 - $130,000

About The Position

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Reporting to the Director, Provider Enrollment and Network Relations, the Supervisors of Provider Enrollment are responsible for the processing and coordination of all provider enrollment transactions. Assures the enrollment team delivers quality services in accordance to BILPN's mission and with all applicable policies, procedures, and professional standards. The Supervisors will monitor both internal and external relationship with health plans, providers and escalated inquiries, and deploy suggested improvements in policy and enrollment processes and the systems that support them to ensure compliance with internal and external standards and to improve efficiency. The Supervisors will also be responsible for initial and ongoing training and educational opportunities for enrollment staff, and continued maintenance of training materials. Operates as the main lead on internal cross-functional teams within BILPN.

Requirements

• High School diploma or GED required.
• 3-5 years related work experience required.
• 0-1 years supervisory/management experience required.
• 3-5 years related work experience in physician group practice management, provider enrollment relations, contract management or credentialing.
• Knowledge of Medicare, Medicaid and behavioral health provider enrollment.
• Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web based applications.
• May produce complex documents, perform analysis and maintain databases.

Nice To Haves

• Bachelor's degree preferred.

Responsibilities

• Provide daily ongoing supervision and feedback to the BILPN enrollment team.
• Supervise, maintains, updates, and oversees policy and procedures of the enrollment function, including enrollment procedures with payors and internal partners.
• Maintains, and tracks delegated credentialing agreements.
• Coordination with PSA on delegation audits for health plans.
• Manages required contractual notifications to payors pertaining to specific providers and applies stringent confidentiality standards with regard to same.
• Assists the director on tracking performance metrics, and implements quality initiatives to enrollment operations; ensures enrollment with payors is completed within required time frames to ensure optimal revenue capture.
• Assures BILPN compliance with regards to enrollment criteria in payor contracts; responsible for understanding the provider information needed for risk contracting.
• Oversees quarterly reconciliation of provider lists and binding authority documentation to ensure adequate enrollment procedures for payors.
• Assists on the distribution, collection, and tracking of participating provider agreements and any related amendments.
• Assists the director on managing the relationships with payors to identify and resolve operational issues between providers and payors that affect enrollment, practice operations, or revenue capture.
• Ensures health plan enrollment occurs in a timely manner.
• Identifies and resolves payor or enrollment related issues that impact the BILPN network.
• Build strong customer relationship-both internal and external and deliver solutions that meet customer expectations.
• Assist, as needed, the coordination of cross-functional projects relating to provider and hospital data; represents BILPN to various internal and external committees.
• Assists the director on developing educational programs for participating providers in response to new legislative directives, e.g. HIPAA, Medicare Reform Act, NPI.
• Assists Develops new administrative processes within BILPN and in concert with practices to ensure that providers comply with these new enrollment requirements.
• Has the authority to direct and support employees daily work activities.
• Has the direct responsibility to undertake the following employment actions: hiring, termination, corrective action and performance reviews.

Benefits

• As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: High school or GED