Operations Supervisor, Provider Enrollment

Job Purpose

The Supervisor, Provider Enrollment is responsible for the supervision and oversight of global staff and policies & procedures, and working closely with the Manager, Provider Enrollment to ensure the credentialing/enrolling of new and established health care providers and other policies/procedures of the department are being followed.

Duties & Responsibilities

Oversee issue resolution for the provider education process regarding application completion and submission

Oversee and ensure that the collection, updating and maintenance of necessary provider information and documentation is completed

Oversee and ensure that the enrollment follow-up, by client and payer, is completed within departmental and client parameters

Ensure that provider enrollment applications for all initial applications and re-credentialing are completed in a timely and complete manner

Ensure verification of provider and group information with insurance companies is completed

Ensure that the information for enrollment and termination of all providers is accurate and communicate to team and clients as appropriate.

Implement and maintain client and Company Q/A standards and protocols and coordinate with department manager quarterly reporting of same

Act as the point of contact to the client to troubleshoot any issues and escalate as needed to management

Contribute to the departmental process and procedures with a collaborative approach

Monitor  provider reports to ensure they are kept current and report any deficiencies in same

Assist in the training and education on enrollment processes or required research for accuracy, ensuring that all training activities are complete and up to date

Document and record training sessions to be used for future reference

Monitor and analyze productivity along with performing Q/A for all staff

Provide timely feedback to offshore provider enrollment regarding Q/A process and results

Identify struggles with Provider Enrollment staff and provide guidance when needed globally

Other duties as assigned

Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Understand and comply with Information Security and HIPAA policies and procedures at all times

Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

High school diploma or equivalent required

Minimum 5 years’ experience in Provider Enrollment required

Knowledge of and experience in healthcare billing preferred

Experience with CAQH required

Proficiency in Microsoft Office Suite

Strong interpersonal skills, ability to communicate well at all levels of the organization

Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses

High level of integrity and dependability with a strong sense of urgency and results oriented 

Excellent written and verbal communication skills required

Working Conditions

Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes

Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear

Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress

Work Environment: The noise level in the work environment is usually minimal

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.