Supv, Prov Enroll-Life Cycle

Corewell Health • Grand Rapids, MI

8d • Onsite

About The Position

Supervises the daily aspects of Provider Operations area, that can include, provider resolution, provider administrative appeals, provider enrollment, provider reimbursement, provider credentialing, and project management of multi-million dollar portfolio assigned and accountable to achieve strategic and operational goals. Ensure adherence and communicates departmental strategic goals, quality & training initiatives, and acts as a liaison for system support issues, to ensure operational efficiencies and continuity of care with providers and members.

Requirements

• 3 years of relevant experience supervision of people and processes within an operations area

Nice To Haves

• Bachelor's Degree or equivalent with emphasis in health care, business management
• 3 years of relevant experience healthcare, insurance, managed care and/or comparable industry
• 7 years of relevant experience in Microsoft applications including Word, PowerPoint, Excel and Business Objects
• 5 years of relevant experience Accreditation and/or regulatory bodies like NCQA, CMS, MDCH, TJC, etc., standards related to credentialing and/or billing, and/or quality auditing requirements.
• 3 years of relevant experience Experience with provider configuration, credentialing, claims and/or comparable systems
• CRT-Provider Credentialing Specialist, Certified (CPCS) - NAMSS National Association Medical Staff Services preferred
• CRT-Professional Medical Services Management, Certified (CPMSM) - UNKNOWN Unknown preferred

Responsibilities

• Supervises the operational efficiencies for the entire network of 82,000+ providers, provider groups, and facilities to resolve complex provider issue (inquiry) resolution, provider reimbursement issues, drives large provider group Operational Committee meetings to identify and establish root cause problem resolution.
• Supervises team members to achieve business goals that include maintaining productivity standards and quality standards.
• Develop, implement and maintain performance tracking and trending tools to allow for monitoring of overall team.
• Acts as project leader on the most complex special projects utilizing project management and technical computer skills to ensure all project activities is completed in an accurate timely manner.
• Serves as the subject matter expert on the end-to-end operational administration for systems set-up, configuration, and issue resolution.
• Supervises the organizational operational efficiencies for the entire network of 82,000+ providers, provider groups, and facilities to ensure precise provider demographic information that persist throughout Priority Health eco system, to ensure correct pay out of the yearly $40M Physician Incentive Program settlement to providers and billion dollar claims payout to providers, establishes and monitors correct primary care provider to member alignment, along with the compliance area ensures the accuracy of Find A Doctor, and ensures IRS compliance with provider financial reporting, i.e. W9.
• Supervisors and implements organizational operational efficiencies of our national provider networks.
• Acts as designate liaison by developing and maintaining purposeful long-term relationship with nation network account representatives, manages claims repricing payment system and repricing claims activities including overall review of claims, manages and ensure annual payment of multi-million dollar access fees are paid accurately and timely to all national networks.
• Monitors as well as develops policies, procedures, and effective controls to ensure that we are compliant with SAS70 and MAR in accordance with all corporate standards.
• Interviews, hires and establishes performance development plans; conducts staff performance discussions.
• Provides support, guidance, leadership and motivation to promote maximum performance.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree